Clough Anthony D, Smith Garett S, Leibman Steven
Royal North Shore Hospital, Sydney, New South Wales, Australia.
Surg Laparosc Endosc Percutan Tech. 2011 Aug;21(4):e190-1. doi: 10.1097/SLE.0b013e31821fd5e1.
Large bowel obstruction by incarceration in the lesser sac through the foramen of Winslow is exceedingly rare and often associated with nonviable bowel at the time of operation according to older reports. In modern times, widespread availability of computed tomography (CT) for investigation of the acute abdomen may decrease the necessity of bowel resection in these cases. Here, we present a case of laparoscopic reduction of viable transverse colon from the lesser sac in a young woman. With the diagnosis suggested by CT, we were able to approach the case with two five millimeter working ports and 1 optical port, reducing the hernia by means of traction on the distal limb of transverse colon. The patient recovered well and was discharged on day 4 postoperative after bowel movement was achieved. Internal hernia represents one of the few cases in which laparoscopy may be the preferred approach to large bowel obstruction.
据以往报道，经网膜孔嵌顿于小网膜囊导致的大肠梗阻极为罕见，且手术时往往伴有肠管坏死。在现代，计算机断层扫描（CT）广泛应用于急腹症检查，这可能会减少此类病例中肠切除的必要性。在此，我们报告一例年轻女性经腹腔镜将小网膜囊内可存活的横结肠复位的病例。根据CT提示的诊断，我们通过两个5毫米的操作孔和1个观察孔对该病例进行处理，通过牵拉横结肠远端肢体将疝复位。患者恢复良好，术后第4天排便后出院。内疝是少数腹腔镜可能是大肠梗阻首选治疗方法的病例之一。
