Sugita Hiroki, Akiyama Takahiko, Daitoku Naoya, Tashima Rumiko, Tanaka Hiroshi, Honda Shinobu, Arita Tetsumasa, Yagi Yasushi, Hirota Masahiko
Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan.
J Surg Case Rep. 2017 May 22;2017(5):rjw217. doi: 10.1093/jscr/rjw217. eCollection 2017 May.
Mesenteric defects are often not closed in laparoscopic colectomy. We herein report a case of an internal hernia projecting through a mesenteric defect following laparoscopy-assisted right hemicolectomy. A 74-year-old woman was hospitalized for the surgical treatment of double colon cancer. Preoperative colonoscopy demonstrated the presence of ascending colon and transverse colon cancers. A laparoscopic-assisted right hemicolectomy was performed. The mesenteric defect resulting from the colectomy was not closed. Three months after the surgery, the patient developed a bowel obstruction. Under a diagnosis of strangulated bowel obstruction, we performed a laparotomy, and found a necrotic small bowel, which had passed into the bursa omentalis through the mesenteric defect. We removed the necrotic small bowel and closed the mesenteric defect by suturing. The patient's postoperative course was uneventful. An internal hernia projecting through a mesenteric defect following laparoscopy-assisted right hemicolectomy developed a severe strangulated bowel obstruction.
在腹腔镜结肠切除术中,肠系膜缺损常常未予闭合。我们在此报告1例腹腔镜辅助右半结肠切除术后经肠系膜缺损突出形成内疝的病例。一名74岁女性因双结肠癌接受手术治疗入院。术前结肠镜检查显示升结肠和横结肠癌。行腹腔镜辅助右半结肠切除术。结肠切除术后形成的肠系膜缺损未予闭合。术后3个月,患者发生肠梗阻。在诊断为绞窄性肠梗阻后,我们实施了剖腹手术,发现一段坏死小肠经肠系膜缺损进入网膜囊。我们切除坏死小肠并通过缝合闭合肠系膜缺损。患者术后恢复顺利。腹腔镜辅助右半结肠切除术后经肠系膜缺损突出形成的内疝发生了严重的绞窄性肠梗阻。