Seya Tomoko, Tanaka Noritake, Yokoi Kimiyoshi, Okada Susumu, Oaki Yoshiharu, Uchida Eiji
Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School.
J Nippon Med Sch. 2010 Apr;77(2):111-4. doi: 10.1272/jnms.77.111.
We report the case of a patient with paraduodenal hernia diagnosed incidentally during an operation for transverse colon cancer. The patient was a 77-year-old woman who complained of dizziness. Laboratory data revealed no abnormal findings except slight anemia. Barium enema and colonoscopic examination revealed an irregular surfaced mass, about 5.0 cm in size, located near the flexure of the spleen of the transverse colon. A biopsy of the mass was performed, and a moderately differentiated adenocarcinoma was diagnosed. In April 2009, following the diagnosis of transverse colon cancer, laparotomy was performed, which revealed that a few loops of the jejunum were herniated through the orifice into the space posterior to the transverse mesocolon. Moreover, the jejunal loops were located right between a shifted left branch of the middle colic artery and ascending left colic artery. There were no ischemic changes in the jejunum. These findings were consistent with a left paraduodenal hernia associated with transverse colon cancer. The scheduled left hemicolectomy was performed in addition to a radical operation of the left paraduodenal hernia. The abdominal computed tomography (CT) images were reviewed postoperatively. The scan projection radiogram obtained by CT revealed a packing of jejunal loops in the middle of the abdomen. Abdominal CT revealed ascending left colic artery at the left edge of a packing of jejunal loops. The patient was discharged from our hospital 14 days after the surgery without any complications. Left paraduodenal hernias are rare and constitute less than 0.4% of all intestinal obstructions. Retrospectively reviewed, the preoperative CT is suggestive. In addition to the packing of jejunal loops in the middle of the abdomen, ascending left colic artery was clearly observed at the left edge of the packing of jejunal loops, which indicates left paraduodenal hernia.
我们报告了一例在横结肠癌手术中偶然诊断出十二指肠旁疝的患者。该患者为一名77岁女性，主诉头晕。实验室检查数据除轻度贫血外无异常发现。钡剂灌肠和结肠镜检查显示，在横结肠脾曲附近有一个大小约5.0 cm、表面不规则的肿块。对该肿块进行了活检，诊断为中度分化腺癌。2009年4月，在诊断为横结肠癌后，进行了剖腹手术，术中发现几段空肠通过孔口疝入横结肠系膜后方的间隙。此外，空肠袢位于中结肠动脉左支移位和左结肠升动脉之间。空肠未见缺血改变。这些发现与横结肠癌相关的左十二指肠旁疝相符。除了对左十二指肠旁疝进行根治性手术外，还进行了预定的左半结肠切除术。术后复查了腹部计算机断层扫描（CT）图像。CT获得的扫描投影X线片显示腹部中部有空肠袢堆积。腹部CT显示在空肠袢堆积的左边缘有左结肠升动脉。患者术后14天从我院出院，无任何并发症。左十二指肠旁疝很少见，占所有肠梗阻的比例不到0.4%。回顾性分析，术前CT有提示作用。除了腹部中部有空肠袢堆积外，在空肠袢堆积的左边缘清晰观察到左结肠升动脉，这提示为左十二指肠旁疝。
