Williams Aaron M, Pickell Zachary, Shen Mary R, Sangji Naveen
University of Michigan, Michigan Medicine, Department of Surgery, Ann Arbor, MI, USA.
Autops Case Rep. 2021 Jan 28;11:e2020236. doi: 10.4322/acr.2020.236. eCollection 2021.
Bowel obstructions can have a variety of causes, including impacted feces, adhesions, volvulus, non-internal hernias, and in rare cases internal hernias. We report a 63-year-old woman who presented to the emergency department with severe abdominal pain, nausea, vomiting, and obstructive symptoms that had started 12 hours earlier. A computed tomographic scan of the abdomen and pelvis showed a right internal hernia with a cecal bascule traversing through the foramen of Winslow, concerning for a closed-loop obstruction. The patient underwent an exploratory laparotomy with cecal bascule reduction and cecopexy. Given the increased mortality risk if undiagnosed, it is important to remain aware of internal hernias. Patient outcomes are markedly improved with early diagnosis and surgical intervention.
肠梗阻可有多种病因,包括粪块嵌塞、粘连、肠扭转、非内疝,罕见情况下也可由内疝引起。我们报告一名63岁女性,因12小时前开始出现的严重腹痛、恶心、呕吐及梗阻症状就诊于急诊科。腹部和盆腔计算机断层扫描显示右侧内疝,盲肠瓣经温氏孔穿出,考虑为闭袢性梗阻。患者接受了剖腹探查术,行盲肠瓣复位及盲肠固定术。鉴于未诊断出内疝会增加死亡风险,因此认识内疝很重要。早期诊断和手术干预可显著改善患者预后。