Morgan Heidi, Chastanet Robert, Lucha Paul A
Transitional Internship Program, Naval Medical Center, Portsmouth, VA 23708-2197, USA.
Postgrad Med. 2008 Jul 31;120(2):E01-5. doi: 10.3810/pgm.2008.07.1787.
Obesity is becoming more common in the United States, affecting > or = 30% of adults aged 20 years and older. Obesity (body mass index 30) is ranked second only to tobacco use as a preventable cause of death in the United States. Roux-en-Y gastric bypass (RYGBP) is being performed at a rapidly increasing rate, and laparoscopic Roux-en-Y gastric bypass (LRYGBP) surgery is frequently chosen rather than an open approach because of lower morbidity rates. One of the complications of LRYGBP includes small bowel obstruction (SBO) secondary to internal herniation. When RYGBP is performed through the open approach, SBO is most commonly caused by adhesions. The challenge with these patients is that the presenting signs, symptoms, and physical and radiological examinations may be vague, nonspecific, and/or nondiagnostic. Internal hernias that result as a complication of LRYGBP occur in 1 of 3 places. These locations include the transverse mesocolon, the jejunal mesenteric defect at the level of the jejunojejunostomy, and Petersen's space, which is the area between the mesentery of the Roux limb and the transverse mesocolon. We report the case of a 45-year-old woman who presented with SBO secondary to Petersen's hernia. The clinical presentation and radiologic studies are discussed.
肥胖在美国正变得越来越普遍，影响着20岁及以上30%或更多的成年人。肥胖（体重指数≥30）是美国仅次于吸烟的可预防死因。Roux-en-Y胃旁路术（RYGBP）的实施率正在迅速上升，由于发病率较低，腹腔镜Roux-en-Y胃旁路术（LRYGBP）手术比开放手术更常被选用。LRYGBP的并发症之一包括因内疝导致的小肠梗阻（SBO）。当通过开放手术进行RYGBP时，SBO最常见的原因是粘连。这些患者面临的挑战是，其出现的体征、症状以及体格检查和影像学检查可能不明确、不具特异性且/或无法确诊。作为LRYGBP并发症出现的内疝发生在三个部位之一。这些部位包括横结肠系膜、空肠空肠吻合口水平的空肠系膜缺损以及Roux袢系膜与横结肠系膜之间的区域即彼得森间隙。我们报告了一例45岁女性因彼得森疝导致SBO的病例。并对临床表现和影像学研究进行了讨论。
