Hosono Shunsuke, Ohtani Hiroshi, Arimoto Yuichi, Kanamiya Yoshitetsu
Department of Surgery, Osaka City Sumiyoshi Hospital, 1-2-16 Higashikagaya, Suminoe-ku, Osaka, 559-0012, Japan.
Surg Today. 2007;37(4):330-4. doi: 10.1007/s00595-006-3405-4. Epub 2007 Mar 26.
A 58-year-old woman underwent laparoscopy-assisted transverse colectomy for transverse colon cancer. On postoperative day 7, she experienced sudden abdominal pain accompanied by vomiting and fever. Computed tomography showed a small bowel obstruction caused by an internal hernia. Laparotomy revealed an internal hernia through the mesenteric defect at the anastomotic colonic stumps, which had not been closed in the previous operation. Almost the entire small bowel protruding through the mesenteric defect was found in the omental bursa. We resected part of the jejunal loop, which was strangulated and congested by an adherent band. Our experience suggests that if the mesenteric defect is relatively small, it should be closed completely during laparoscopy-assisted colectomy; however, more studies are required to determine the indications for closure of the mesenteric defect to prevent this complication.
一名58岁女性因横结肠癌接受了腹腔镜辅助横结肠切除术。术后第7天,她突然出现腹痛并伴有呕吐和发热。计算机断层扫描显示由内疝引起的小肠梗阻。剖腹手术发现内疝通过吻合口结肠残端处的肠系膜缺损形成,该缺损在先前手术中未闭合。几乎整个通过肠系膜缺损突出的小肠都位于网膜囊内。我们切除了部分被粘连带绞窄和充血的空肠袢。我们的经验表明,如果肠系膜缺损相对较小,在腹腔镜辅助结肠切除术中应完全闭合;然而,需要更多研究来确定肠系膜缺损闭合的指征以预防这种并发症。