Leal-González Raúl, De la Garza-Ramos Rafael, Guajardo-Pérez Horacio, Ayala-Aguilera Fernando, Rumbaut Roberto
Tecnológico de Monterrey, School of Medicine and Health Sciences, Mexico.
Int J Surg Case Rep. 2013;4(1):44-7. doi: 10.1016/j.ijscr.2012.10.006. Epub 2012 Oct 13.
Gastric bypass surgery is the most common obesity surgery procedure in women. Decreased weight loss favors fertility and leads to pregnancy sometimes just months after surgery, raising the risk of developing gastric bypass-related complications during pregnancy, including the formation of internal hernias.
The first patient presented at 37 weeks of gestation with abdominal pain, nausea and vomiting. X-ray revealed multiple air-fluid levels and absence of gas in colon. She underwent a cesarean section and exploratory laparotomy without complications. A Petersen's space internal hernia was found. The second patient presented at 25 weeks of gestation with abdominal pain and nausea. X-ray revealed multiple air-fluid levels and a "U-shaped" intestinal loop. She underwent exploratory laparotomy with reduction of an internal hernia also in Petersen's space.
Pregnant patients with internal hernias after gastric bypass are usually of young age and with a several-day history of abdominal pain. Surgical exploration is safe and should not be delayed. The literature review showed that maternal death (9%) and fetal death (13.6%) rates are considerably high.
The possibility of an internal hernia should always be considered in pregnant women with history of gastric bypass who present with abdominal pain, in order to prevent catastrophic outcomes such as maternal and/or fetal death.
胃旁路手术是女性中最常见的肥胖症手术。体重减轻减少有利于生育，有时术后仅数月就会导致怀孕，这增加了孕期发生胃旁路相关并发症的风险，包括形成内疝。
首例患者在妊娠37周时出现腹痛、恶心和呕吐。X线显示多个气液平面且结肠内无气体。她接受了剖宫产和探查性剖腹手术，未出现并发症。发现了彼得森间隙内疝。第二例患者在妊娠25周时出现腹痛和恶心。X线显示多个气液平面和一个“U形”肠袢。她接受了探查性剖腹手术，同时还还纳了彼得森间隙内的内疝。
胃旁路术后发生内疝的孕妇通常较为年轻，且有几天的腹痛病史。手术探查是安全的，不应延迟。文献综述显示，孕产妇死亡率（9%）和胎儿死亡率（13.6%）相当高。
有胃旁路手术史且出现腹痛的孕妇应始终考虑内疝的可能性，以防止出现如孕产妇和/或胎儿死亡等灾难性后果。
