Fujimoto Yuka, Ohya Yuki, Hayashida Shintaro, Iizaka Masayoshi, Maeda Yuto, Kumamoto Sayahito, Tsuji Akira, Shibata Hidekatsu, Kuramoto Kunitaka, Hayashi Hironori, Nakahara Osamu, Tomiyasu Shinjiro, Inomata Yukihiro
Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan.
Surg Case Rep. 2020 Mar 18;6(1):53. doi: 10.1186/s40792-020-00815-y.
Transomental hernias are a rare type of internal hernia. We report two cases of successful cases of laparoscopic repair. One required laparotomy due to concern for intestinal viability.
The first patient was a 67-year-old man who presented with abdominal pain and vomiting. He had no history of laparotomy or abdominal injury. Computed tomography suggested small bowel obstruction and possible intestinal strangulation. Emergent laparoscopy found approximately 200 cm of small bowel was strangulated around the greater omentum. The strangulation was released laparoscopically, but because of the color of the strangulated bowel, laparotomy was performed to evaluate viability. The involved portion of intestine was not resected. The patient experienced transient postoperative paralytic ileus and was discharged on postoperative day 14. The second patient was a 56-year-old man who presented with abdominal pain. Abdominal computed tomography revealed dilatation of the small intestine and a closed loop suggesting ileus due to intestinal strangulation. An emergency laparoscopy found a transomental hernia, and the strangulation was released laparoscopically. Recovery was uneventful, and the patient was discharged on postoperative day 6.
Transomental hernia can be successfully treated laparoscopically. In cases where bowel viability is a concern, laparotomy should not be hesitated.
经网膜疝是一种罕见的内疝类型。我们报告两例腹腔镜修复成功的病例。其中一例因担心肠管活力而需要开腹手术。
首例患者为一名67岁男性，表现为腹痛和呕吐。他既往无开腹手术或腹部外伤史。计算机断层扫描提示小肠梗阻及可能的肠绞窄。急诊腹腔镜检查发现约200厘米的小肠被大网膜绞窄。腹腔镜下解除绞窄，但由于绞窄肠管的颜色，进行了开腹手术以评估肠管活力。未切除受累肠段。患者术后出现短暂性麻痹性肠梗阻，于术后第14天出院。第二例患者为一名56岁男性，表现为腹痛。腹部计算机断层扫描显示小肠扩张及一个闭合肠袢，提示因肠绞窄导致肠梗阻。急诊腹腔镜检查发现经网膜疝，腹腔镜下解除绞窄。恢复顺利，患者于术后第6天出院。
经网膜疝可通过腹腔镜成功治疗。在担心肠管活力的情况下，应毫不犹豫地进行开腹手术。
