Nawabi Atta, Kahle Adam C, King Clay D, Nawabi Perwaiz
The University of Kansas, Department of Surgery, Kansas City, KS, USA.
Third year medical student at the Kansas City University, Kansas City MO, USA.
J Surg Case Rep. 2020 Nov 30;2020(11):rjaa467. doi: 10.1093/jscr/rjaa467. eCollection 2020 Nov.
Para duodenal hernias, the most common type of retroperitoneal hernias, are thought to occur naturally from abnormal gut rotation because of fusion folds within the peritoneum. Retroperitoneal hernias are a rare postoperative complication and have not been described after renal transplantation via a retroperitoneal approach. This case report presents a 48-year-old male with intestinal obstruction after renal transplant due to herniation into the retroperitoneum via an incidentally created peritoneal defect. We suggest computed tomography with oral contrast be used in the early postoperative phase to assess for obstruction in patients with prolonged ileus of unclear etiology who have undergone retroperitoneal dissection. Small peritoneal defects should be closed during dissection. Larger, or multiple peritoneal defects should be extended to make a single, large defect to decrease the possibility of bowel herniating and becoming incarcerated.
十二指肠旁疝是腹膜后疝最常见的类型，被认为是由于腹膜内融合襞导致肠道异常旋转自然发生的。腹膜后疝是一种罕见的术后并发症，经腹膜后途径进行肾移植后尚未见相关报道。本病例报告介绍了一名48岁男性，肾移植术后因通过偶然形成的腹膜缺损疝入腹膜后而发生肠梗阻。我们建议在术后早期使用口服对比剂的计算机断层扫描，以评估病因不明的长时间肠梗阻且接受过腹膜后解剖的患者是否存在梗阻。在解剖过程中应封闭小的腹膜缺损。较大的或多个腹膜缺损应扩大成一个大的缺损，以降低肠管疝出并发生嵌顿的可能性。
