Kuenzler Keith A, Wolfson Philip J, Murphy Stephen G
A.I. duPont Hospital for Children, Wilmington, DE 19899, USA.
J Pediatr Surg. 2003 Aug;38(8):1241-3. doi: 10.1016/s0022-3468(03)00277-x.
The authors present the case report of a 13-year-old boy in whom organoaxial gastric volvulus developed four months after a laparoscopic Nissen fundoplication and placement of gastrostomy. Intraoperative findings were significant for volvulus about an axis defined by 2 fixation points, one at the fundoplication site and the other in the area of the gastrostomy tube, positioned close to the pylorus. Of the 142 pediatric cases of gastric volvulus reported to date, only 7 describe it as a complication subsequent to gastric surgery, and just one case has been reported after laparoscopic Nissen fundoplication. This case shows that fundoplication and gastrostomy, a recommended treatment for gastric volvulus, does not always preclude its development. Increasing numbers of pediatric surgeons are performing laparoscopic Nissen fundoplication procedures. The authors advise surgeons to consider this potentially fatal complication, both intraoperatively when selecting a location for gastrostomy and postoperatively when evaluating complaints.
作者报告了一例13岁男孩的病例，该男孩在腹腔镜下进行尼氏胃底折叠术和胃造口术后四个月发生了器官轴型胃扭转。术中发现，围绕由两个固定点确定的轴发生了扭转，一个固定点在胃底折叠术部位，另一个在胃造口管区域，靠近幽门。在迄今为止报道的142例小儿胃扭转病例中，只有7例将其描述为胃手术后的并发症，腹腔镜下尼氏胃底折叠术后仅报道过1例。该病例表明，作为胃扭转推荐治疗方法的胃底折叠术和胃造口术并不总能预防其发生。越来越多的小儿外科医生在进行腹腔镜下尼氏胃底折叠术。作者建议外科医生在术中选择胃造口位置时以及术后评估患者主诉时，都要考虑到这种潜在的致命并发症。
