Kannan Umashankkar, Gupta Ranjan, Gilchrist Brian F, Kella Venkata N
General Surgery, Bronx-Lebanon Hospital Center, Bronx, New York, USA.
BMJ Case Rep. 2018 Apr 19;2018:bcr-2017-221979. doi: 10.1136/bcr-2017-221979.
Management of abdominal pain in a pregnant patient with a history of Roux-en-Y gastric bypass presents unique challenges. A misdiagnosis or delay in management can result in lethal maternal-fetal outcomes. We present a 30-year-old woman at 21 weeks of pregnancy presented with abdominal pain. She had a history of laparoscopic Roux-en-Y gastric bypass performed 3 years earlier. The clinical examination was remarkable for epigastric pain and tenderness. The vital signs and laboratory examinations were unremarkable. The CT scan was suggestive of an internal hernia. On an exploratory laparoscopy, the distal common small bowel was found to be herniating through the jejunojejunostomy mesenteric defect, causing intestinal obstruction with dilatation of the Roux limb and the biliopancreatic limb. The internal hernia was reduced, and no bowel resection was required. The mesenteric defect was closed with 3-0 silk sutures in a continuous fashion. The patient was discharged after 3 days and delivered a healthy baby at 40 weeks of gestation.
对于有Roux-en-Y胃旁路手术史的孕妇，腹痛的管理存在独特挑战。误诊或管理延误可能导致致命的母婴结局。我们报告一名30岁女性，孕21周时出现腹痛。她3年前曾行腹腔镜Roux-en-Y胃旁路手术。临床检查发现上腹部疼痛和压痛明显。生命体征和实验室检查无异常。CT扫描提示内疝。在 exploratory laparoscopy中，发现远端空肠通过空肠吻合口肠系膜缺损疝出，导致肠梗阻，Roux袢和胆胰袢扩张。内疝复位，无需肠切除。肠系膜缺损用3-0丝线连续缝合关闭。患者3天后出院，妊娠40周时产下一名健康婴儿。 （注：“exploratory laparoscopy”可译为“探查性腹腔镜检查” ）
