Cao Yuchen, Isogaki Jun, Kohga Atsushi, Okumura Takuya, Yamashita Kimihiro, Suzuki Kenji, Kawabe Akihiro
Division of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan.
J Surg Case Rep. 2018 Nov 23;2018(11):rjy318. doi: 10.1093/jscr/rjy318. eCollection 2018 Nov.
Transmesenteric hernia is a rare cause of small bowel strangulation in adults and, to our knowledge, no one has reported the existence of two mesenteric defects in an adult. Our patient was a 73-year-old Japanese woman who presented to our emergency department complaining of abdominal pain and nausea. Computed tomography with contrast enhancement revealed a closed loop obstruction in the pelvis, suggesting small bowel strangulation due to an internal hernia. The emergency exploratory laparotomy indicated a small bowel strangulation caused by a transmesenteric hernia. With the examination across whole parts of the mesentery, we identified another small defect. Both defects were closed by suture intraoperatively, and the patient's postoperative course was satisfactory. Searching for whole parts of the mesentery after the reduction of a hernia can help prevent the recurrence of internal hernias.
肠系膜疝是成人小肠绞窄的罕见原因，据我们所知，尚无成人存在两个肠系膜缺损的报道。我们的患者是一名73岁的日本女性，因腹痛和恶心到我院急诊科就诊。增强计算机断层扫描显示盆腔内有闭袢性肠梗阻，提示内疝导致小肠绞窄。急诊剖腹探查显示为肠系膜疝引起的小肠绞窄。在对整个肠系膜进行检查时，我们发现了另一个小缺损。术中通过缝合将两个缺损都封闭了，患者术后恢复过程顺利。在疝复位后对整个肠系膜进行检查有助于预防内疝复发。
