Rehfuss Jonathan P, Friedman Jeffrey E, Tan Sanda A, Lottenberg Lawrence L, Goldstein Lindsey E
Department of Surgery, University of Florida, Gainesville, FL, USA.
Department of Surgery, Florida Atlantic University/St. Mary's Medical Center, West Palm Beach, FL, USA.
J Surg Case Rep. 2018 Sep 11;2018(9):rjy241. doi: 10.1093/jscr/rjy241. eCollection 2018 Sep.
Cecal volvulus is the rotation of a mobile cecum resulting in a large bowel obstruction. We present the case of a 55-year-old female who underwent a roux-en-y gastric bypass in 2003 and presented to the emergency department with worsening abdominal pain, distention and obstipation. Roentgenogram demonstrated a 14 cm colon suggestive of sigmoid volvulus, but CT scan showed rectal contrast abruptly ending in the distal transverse colon, mesenteric swirling and a distended cecum, consistent with cecal, rather than sigmoid, volvulus. Upon surgical exploration the majority of the small bowel, cecum and ascending colon had herniated through the transverse mesocolon defect created during her prior gastric bypass. The bowel was reduced through the mesenteric defect, and an ileocecectomy was performed. This is, to our knowledge, the first reported case of cecal volvulus caused by an internal hernia through a mesocolon defect created during a prior roux-en-y gastric bypass operation.
盲肠扭转是指活动盲肠发生旋转，导致大肠梗阻。我们报告一例55岁女性病例，该患者于2003年接受了Roux-en-Y胃旁路手术，现因腹痛加剧、腹胀和便秘就诊于急诊科。X线片显示一段14厘米的结肠，提示乙状结肠扭转，但CT扫描显示直肠造影剂在远侧横结肠突然终止，肠系膜漩涡形成，盲肠扩张，符合盲肠扭转而非乙状结肠扭转。手术探查发现，大部分小肠、盲肠和升结肠通过先前胃旁路手术造成的横结肠系膜缺损疝出。通过肠系膜缺损将肠管复位，并进行了回盲肠切除术。据我们所知，这是首例因先前Roux-en-Y胃旁路手术造成的结肠系膜缺损导致内疝引起盲肠扭转的病例报告。
