Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI 48075, USA.
Hernia. 2013 Feb;17(1):137-9. doi: 10.1007/s10029-011-0840-y. Epub 2011 Jun 12.
Retroperitoneal hernias are rare. When they occur, they most often occur in naturally occurring fossas, such as with paraduodenal hernias. Due to the anatomy of the ureterovesicular system, patients with prior urological operations may be more likely to develop retroperitoneal hernias. We report the case of a 76-year-old male who had undergone a radical cystectomy with ileal loop conduit for bladder cancer, who presented with recurrent episodes of nausea and vomiting. Upon exploratory laparotomy, he was found to have a retroperitoneal hernia. The patient underwent resection of the strangulated loop of small bowel, and recovered without complications. In our patient, ureteral dissection from his prior procedure had created a defect in the peritoneum posterior to the sigmoid mesocolon, which allowed for herniation and subsequent strangulation of a portion of small bowel. Retroperitoneal hernias may represent an under-diagnosed etiology of intestinal obstruction in post-operative urological patients. Knowledge of anatomy is crucial in patients with previous abdominal operations, and prior operative notes should be reviewed, including non general surgical operations such as urological and gynecological procedures. The surgeon must remain vigilant in such cases of small bowel obstruction, as delayed intervention may lead to bowel compromise.
腹膜后疝很少见。当它们发生时，它们最常发生在自然存在的袋狸中，如十二指肠旁疝。由于输尿管膀胱系统的解剖结构，先前接受过泌尿外科手术的患者可能更容易发生腹膜后疝。我们报告了一例 76 岁男性的病例，他因膀胱癌接受了根治性膀胱切除术和回肠 loop 导管术，出现反复恶心和呕吐。剖腹探查时发现他患有腹膜后疝。患者接受了绞窄性小肠环的切除，无并发症恢复。在我们的患者中，输尿管从先前的手术中分离出来，在乙状结肠系膜后腹膜上造成了一个缺陷，这允许部分小肠疝出并随后绞窄。腹膜后疝可能是术后泌尿外科患者肠梗阻的一个未被充分诊断的病因。对于先前有腹部手术的患者，了解解剖结构至关重要，应仔细审查先前的手术记录，包括泌尿外科和妇科等非普通外科手术。对于此类小肠梗阻，外科医生必须保持警惕，因为延迟干预可能导致肠损伤。
