Shockcor Nicole, Nzara Rumbidzayi, Pal Anam, Lo Menzo Emanuele, Kligman Mark D
Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
J Surg Case Rep. 2020 Dec 7;2020(12):rjaa466. doi: 10.1093/jscr/rjaa466. eCollection 2020 Dec.
Congenital anomalies of midgut rotation are uncommon with a 0.2-0.5% incidence. Intestinal malrotation (IM) presents a unique challenge in bariatric surgery during laparoscopic gastric bypass (LRYGB), and familiarity with alternatives allows for safe laparoscopic intervention. IM was encountered in 5 of 1183 (0.4%) patients undergoing surgery. Once IM was suspected, a standardized approach was applied: rightward shift of ports, confirmation of IM by the absence of the ligament of Treitz, identification of the duodenojejunal junction, lysis of Ladd's bands, mirror-image construction of the Roux limb and construction of the gastrojejunal anastomosis. Forty percent were male, age 33 ± 8 years, with body mass index 50 kg/m (37-75 kg/m). IM was identified preoperatively in two patients (40%). All operations were completed laparoscopically. Despite the finding of IM, successful laparoscopic completion of gastric bypass can be anticipated if the surgeon has an understanding of the anatomic alterations and a strategy for intraoperative management.
中肠旋转先天性异常并不常见，发病率为0.2%-0.5%。在腹腔镜胃旁路手术（LRYGB）的减重手术中，肠旋转不良（IM）带来了独特的挑战，熟悉替代方法有助于进行安全的腹腔镜干预。在1183例接受手术的患者中，有5例（0.4%）出现IM。一旦怀疑有IM，就采用标准化方法：将端口向右移位，通过无Treitz韧带确认IM，确定十二指肠空肠交界处，松解Ladd束，构建Roux袢的镜像结构以及构建胃空肠吻合术。40%为男性，年龄33±8岁，体重指数为50kg/m²（37-75kg/m²）。两名患者（40%）术前确诊为IM。所有手术均通过腹腔镜完成。尽管发现了IM，但如果外科医生了解解剖结构改变并掌握术中管理策略，仍可预期腹腔镜胃旁路手术成功完成。
