Minami Hironori, Nagasaki Toshiya, Akiyoshi Takashi, Konishi Tsuyoshi, Fujimoto Yoshiya, Nagayama Satoshi, Fukunaga Yosuke, Fukuoka Hironori, Ueno Masashi
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Asian J Endosc Surg. 2018 Nov;11(4):409-412. doi: 10.1111/ases.12458. Epub 2018 Jan 4.
Bowel herniation through the space between the exposed structures after pelvic lymphadenectomy is a very rare cause of postoperative bowel obstruction. Here, a case of laparoscopic release of bowel migration into the space after pelvic lymphadenectomy is described. This is the seventh such reported case in the world. A 38-year-old woman who had a history of undergoing laparoscopic radical hysterectomy and bilateral pelvic lymphadenectomy for cervical cancer was diagnosed with strangulated bowel obstruction. Emergency laparoscopic surgery was performed, and bowel migration into the space between the right umbilical artery and the obturator nerve was detected. The loop of strangulated bowel was released laparoscopically, and bowel blood flow was improved. To prevent recurrence of bowel migration, the umbilical artery was resected. It is very important to consider the possibility of bowel herniation into the space between exposed structures in patients with bowel obstruction after minimally invasive pelvic lymphadenectomy.
盆腔淋巴结清扫术后肠管通过暴露结构之间的间隙发生疝出是术后肠梗阻非常罕见的原因。在此，描述了一例腹腔镜下松解盆腔淋巴结清扫术后肠管移入该间隙的病例。这是世界上第七例此类报道病例。一名38岁女性，有因宫颈癌接受腹腔镜根治性子宫切除术和双侧盆腔淋巴结清扫术的病史，被诊断为绞窄性肠梗阻。进行了急诊腹腔镜手术，发现肠管移入右脐动脉和闭孔神经之间的间隙。通过腹腔镜松解绞窄的肠袢，改善了肠管血流。为防止肠管再次移入，切除了脐动脉。对于微创盆腔淋巴结清扫术后发生肠梗阻的患者，考虑肠管疝入暴露结构之间间隙的可能性非常重要。
