Hirashima Kotaro, Ishikawa Takashi, Kosugi Shin-Ichi, Kano Yosuke, Sato Yu, Ichikawa Hiroshi, Hanyu Takaaki, Bamba Takeo, Wakai Toshifumi
Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chu-o-ku, Niigata, 951-8510 Japan.
Surg Case Rep. 2015;1(1):49. doi: 10.1186/s40792-015-0051-3. Epub 2015 Jun 16.
Internal hernia after gastrectomy is a rare complication. It can progress rapidly to vascular disturbance, necrosis, and perforation, therefore early diagnosis and surgical treatment is essential. We present a case of internal hernia following laparoscopic-assisted proximal gastrectomy with jejunal interposition reconstruction in a 68-year-old man, who presented with acute abdominal pain and vomiting. Computed tomography showed a whirl sign, ascites, and a closed-loop formation of the small intestine. We diagnosed an internal hernia and performed emergency surgery. Laparotomy revealed chyle-like ascites and extensive small intestine with poor color. We recognized that about 20 cm of jejunum from the ligament of Treitz was strangulated behind the pedicle of the jejunum lifted during laparoscopic-assisted proximal gastrectomy. We relieved the strangulation, whereupon the color of the strangulated intestine was restored. Therefore, we did not perform intestinal resection and reconstruction. Finally, we fixed the jejunal pedicle and mesentery of the transverse colon. We report this case as there are few reported cases of internal hernia after laparoscopic-assisted proximal gastrectomy.
胃切除术后内疝是一种罕见的并发症。它可迅速发展为血管紊乱、坏死和穿孔，因此早期诊断和手术治疗至关重要。我们报告一例68岁男性在腹腔镜辅助近端胃切除并空肠间置重建术后发生内疝的病例，该患者表现为急性腹痛和呕吐。计算机断层扫描显示有漩涡征、腹水及小肠闭袢形成。我们诊断为内疝并进行了急诊手术。剖腹探查发现乳糜样腹水及广泛的小肠颜色不佳。我们发现，在腹腔镜辅助近端胃切除术中提起的空肠蒂后方，Treitz韧带以下约20 cm的空肠发生了绞窄。我们解除了绞窄，随后绞窄肠段的颜色恢复。因此，我们未进行肠切除和重建。最后，我们固定了空肠蒂和横结肠系膜。由于腹腔镜辅助近端胃切除术后内疝的报道病例较少，我们报告了此病例。
