Rulli Francesco, Galatà Gabriele, Micossi Chiara, Dell'isola Carlo
Department of Surgery, University of Rome Tor Vergata, Roma, Italia.
J Minim Access Surg. 2006 Dec;2(4):222-3. doi: 10.4103/0972-9941.28185.
The adverse physiological effects of pneumo and retro-peritoneum are relatively well known. However, the clinical implications of compromised mesenteric circulation through several mechanical and physiological mechanisms are not as well recognized. We describe a fatal case of intestinal infarction following an elective retroperitoneoscopic right sympathectomy. The patient was a 88-year-old man who died 30 hours after an uneventful anesthesia and right endoscopic lumbar sympathectomy. An emergency explorative laparotomy revealed a massive intestinal infarction due to thrombosis of the superior mesenteric artery. We reviewed the literature on laparoscopic procedures and mesenteric ischemia. To our knowledge, this is the first reported case of intestinal infarction following retro-pneumoperitoneum. We conclude that the presence of a severe multidistrectual? arteriopathy may represent a major risk factor in retroperitoneoscopic procedures.
气腹和后腹膜的不良生理影响相对较为人所知。然而，通过多种机械和生理机制导致的肠系膜循环受损的临床意义尚未得到充分认识。我们描述了一例择期后腹腔镜右侧交感神经切除术术后发生肠梗死的致命病例。患者为一名88岁男性，在麻醉和右侧内镜下腰椎交感神经切除术后顺利的情况下，30小时后死亡。急诊剖腹探查显示因肠系膜上动脉血栓形成导致大面积肠梗死。我们回顾了关于腹腔镜手术和肠系膜缺血的文献。据我们所知，这是第一例报道的后气腹术后肠梗死病例。我们得出结论，严重的多节段动脉病变可能是后腹腔镜手术的一个主要危险因素。
