Polychronidis A, Tsaroucha A K, Karayiannakis A J, Perente S, Efstathiou E, Simopoulos C
Second Department of Surgery, Democritus University of Thrace, Alexandroupolis, Greece.
J Int Med Res. 2005 May-Jun;33(3):360-3. doi: 10.1177/147323000503300312.
We report a case of delayed perforation of the large bowel because of thermal injury during a laparoscopic cholecystectomy. A 78-year-old male with symptomatic cholelithiasis underwent a difficult laparoscopic cholecystectomy because of multiple adhesions resulting from two previous cholecystitis episodes. The patient recovered well after surgery and was discharged on post-operative day 2. On postoperative day 10, the patient returned to the hospital with peritonitis. An exploratory laparotomy revealed perforation of the wall of the hepatic flexure of the large bowel, which was centred in a necrotic area 1 cm in diameter. The perforation was sutured and a temporary ileostomy performed, which was closed at a later date. The patient was doing well at a 10-month follow-up review. A delayed rupture of any part of the bowel after laparoscopic surgery can be potentially fatal if not treated during an emergency exploratory laparotomy, even if the clinical signs are not severe.
我们报告一例因腹腔镜胆囊切除术期间热损伤导致的大肠延迟穿孔病例。一名78岁有症状胆结石的男性因既往两次胆囊炎发作导致多处粘连，接受了困难的腹腔镜胆囊切除术。患者术后恢复良好，术后第2天出院。术后第10天，患者因腹膜炎返回医院。剖腹探查发现大肠肝曲肠壁穿孔，穿孔位于直径1cm的坏死区域中心。穿孔处进行了缝合，并实施了临时回肠造口术，随后关闭。在10个月的随访复查中，患者情况良好。腹腔镜手术后肠道任何部位的延迟破裂，如果在紧急剖腹探查时未得到治疗，即使临床症状不严重，也可能是致命的。
