Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
Surg Today. 2013 Jul;43(7):814-7. doi: 10.1007/s00595-012-0264-z. Epub 2012 Jul 21.
We herein report a case of an internal hernia projecting through a mesenteric defect following laparoscopic-assisted colectomy to the lesser omental cleft in a 61-year-old female. We performed laparoscopic-assisted partial resection of the transverse colon to treat transverse colon cancer. Three years and 6 months after the operation, the patient developed a bowel obstruction requiring surgical intervention. When we observed the intraperitoneal space under laparoscopy, we determined that the small intestine had passed into the bursa omentalis through the mesenteric defect. Additionally, an abnormal opening of the lesser omentum was present with a portion of the small intestine escaping into the space inferior to the liver. We performed reintegration of the escaped bowel and closed the mesenteric defect laparoscopically. This is the first case of an internal hernia projecting through a mesenteric defect following laparoscopic-assisted colectomy that we have experienced out of more than 2400 cases. Further research is needed to identify the patients who would benefit from the closure of mesenteric defects during laparoscopic-assisted colectomy.
我们在此报告一例 61 岁女性患者，在腹腔镜辅助结肠切除术后，通过小网膜裂孔发生肠系膜缺损内疝。我们行腹腔镜辅助横结肠癌部分切除术。术后 3 年 6 个月，患者出现肠梗阻，需要手术干预。当我们在腹腔镜下观察腹腔内空间时，发现小肠通过肠系膜缺损进入小网膜囊。此外，小网膜存在异常开口，部分小肠脱出至肝下间隙。我们进行了脱出肠管的复位，并经腹腔镜关闭了肠系膜缺损。这是我们在 2400 多例腹腔镜辅助结肠切除术后经历的首例肠系膜缺损内疝。需要进一步研究以确定哪些患者从腹腔镜辅助结肠切除术中肠系膜缺损的关闭中受益。
