Takahashi Yusuke, Kobayashi Akira, Seki Hitoshi
Department of Digestive Surgery, Nagano Municipal Hospital, Nagano, Japan.
J Surg Case Rep. 2020 Jul 31;2020(7):rjaa196. doi: 10.1093/jscr/rjaa196. eCollection 2020 Jul.
Our patient was a 59-year-old woman with past history of hysterectomy, bilateral salpingo-oophorectomy, regional lymphadenectomy and omentectomy performed for advanced ovarian cancer. She was experiencing abdominal pain over the past 2 days and visited our hospital owing to pain exacerbation. Contrast-enhanced computed tomography revealed free air around the liver, ascites and duodenal perforation; thus, emergent abdominal surgery was performed. The 5-mm duodenal perforation at the anterior wall of the duodenal bulb was sutured with absorbable thread. We used ligamentum teres hepatis (LTH) as a patch for the sutured site as the greater omentum could not be used. The postoperative course was uneventful, and she was discharged on postoperative Day 8. There were no complications 1 month after surgery. Although the greater omentum is conventionally used for upper gastrointestinal perforation, the LTH was a plausible alternative with good indication in our case.
我们的患者是一名59岁女性，既往因晚期卵巢癌接受过子宫切除术、双侧输卵管卵巢切除术、区域淋巴结清扫术和大网膜切除术。她在过去2天一直腹痛，因疼痛加剧前来我院就诊。增强计算机断层扫描显示肝脏周围有游离气体、腹水和十二指肠穿孔；因此，进行了急诊腹部手术。用可吸收缝线缝合十二指肠球部前壁5毫米的十二指肠穿孔。由于无法使用大网膜，我们使用肝圆韧带（LTH）作为缝合部位的补片。术后过程顺利，她于术后第8天出院。术后1个月无并发症。尽管传统上使用大网膜治疗上消化道穿孔，但在我们的病例中，肝圆韧带是一个合理的替代选择，且适应证良好。
