Mala Tom, Kristinsson Jon
Avdeling for gastro- og barnekirurgi, Oslo universitetssykehus, Norway.
Tidsskr Nor Laegeforen. 2013 Mar 19;133(6):640-4. doi: 10.4045/tidsskr.12.1113.
Approximately 3,000 bariatric operations are performed in Norway annually. Laparoscopic gastric bypass is the most widely used procedure. Internal hernia is a potentially serious cause of acute abdominal pain after a gastric bypass.
The review is based on a discretionary selection of articles found in PubMed coupled with the authors' personal clinical experience.
Internal hernias due to protrusion of the bowel through mesenterial defects, or slits, occur in approximately 0-10% of patients after a gastric bypass. The incidence depends on follow-up time, surgical technique and whether the mesenterial slits were closed during the operation. The pain may be acute, intense and prolonged, with nausea and vomiting, or intermittent, following food intake. Cases of acute pain may be due to obstruction of and reduced blood circulation to the bowel, and require an emergency operation. A CT scan may reveal or arouse suspicion of an obstruction, but cannot rule it out. Pregnancy is a risk factor, and fertile women should be informed of this. Many recommend closure of mesenterial slits during the primary operation to reduce the risk of hernia.
Internal hernia after a gastric bypass is a potentially serious and not uncommon complication requiring rapid surgical intervention. All departments with preparedness for emergency abdominal surgery should be aware of this condition.
挪威每年约进行3000例减肥手术。腹腔镜胃旁路术是最常用的术式。内疝是胃旁路术后急性腹痛的一个潜在严重原因。
本综述基于在PubMed上自行筛选的文章以及作者的个人临床经验。
胃旁路术后，约0%至10%的患者会出现因肠管通过肠系膜缺损或裂隙突出而导致的内疝。其发生率取决于随访时间、手术技术以及术中肠系膜裂隙是否闭合。疼痛可能是急性、剧烈且持续的，伴有恶心和呕吐，或在进食后呈间歇性。急性疼痛病例可能是由于肠管梗阻和血液循环减少所致，需要急诊手术。CT扫描可能显示或引发对梗阻的怀疑，但无法排除梗阻。怀孕是一个危险因素，应告知育龄妇女这一点。许多人建议在初次手术时闭合肠系膜裂隙以降低疝的风险。
胃旁路术后内疝是一种潜在严重且并不罕见的并发症，需要迅速进行手术干预。所有具备急诊腹部手术能力的科室都应了解这种情况。
