Sala-Hernández Ángela, Pous-Serrano Salvador, Lucas-Mera Elí, Carvajal-Amaya Nicolás
cirugia digestiva, Hospital Universitario y Politécnico La Fe, españa.
Cirugia General, Hospital Universitario y Politécnico La Fe.
Rev Esp Enferm Dig. 2016 Mar;108(3):163-4. doi: 10.17235/reed.2016.4024/2015.
Acute colonic volvulus accounts for 10% of all intestinal obstructions being the transverse colon volvulus an exceptional localization (2-4%). Late diagnosis is made as there are no pathognomonic clinical or radiological findings for this pathology. We present the case of an 81 year-old male with acute transverse colon volvulus that involved the gastric antrum causing irreversible ischemia. Subtotal gastrectomy, subtotal colectomy and reconstruction with Y en Roux gastrojejunostomy and ileosigmoid anastomosis was performed given the good overall status of the patient. Decompressive colonoscopy is not advised given the high probability of ischemic lesions in these cases; surgical exploration is mandatory in these circumstances. Surgical detortion with or without colopexia carries important recurrence rates. Treatment of choice includes colectomy with or without primary anastomosis. There are no reports on gastric ischemic necrosis in the setting of a transverse colon volvulus making this case unusual and unique.
急性结肠扭转占所有肠梗阻的10%，横结肠扭转是一种罕见的部位（2%-4%）。由于这种病理情况没有特征性的临床或影像学表现，所以诊断较晚。我们报告一例81岁男性急性横结肠扭转病例，该扭转累及胃窦，导致不可逆性缺血。鉴于患者总体状况良好，实施了胃大部切除术、结肠次全切除术，并采用Y型空肠袢式胃空肠吻合术和回肠乙状结肠吻合术进行重建。鉴于这些病例中缺血性病变的高发生率，不建议进行减压结肠镜检查；在这种情况下，手术探查是必要的。无论是否进行结肠固定术，手术复位都有较高的复发率。首选治疗方法包括有或无一期吻合的结肠切除术。在横结肠扭转的情况下，尚无胃缺血性坏死的报道，使得该病例不同寻常且独一无二。
