General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
BMJ Case Rep. 2021 Dec 7;14(12):e245024. doi: 10.1136/bcr-2021-245024.
A 30-year-old man presented with colicky abdominal pain for 2 months, associated with occasional episodes of bilious vomiting. He had a history of similar complaints at the age of 16 and 26 years. Contrast-enhanced computed tomography abdomen was consistent with a diagnosis of left paraduodenal hernia. On laparoscopy a 3 × 3 cm hernial defect was identified in the left paraduodenal fossa (fossa of Landzert). Contents were jejunal, and proximal ileal loops which were dilated and edematous. Anterior border of the sac was formed by the inferior mesenteric vein and left branch of the left colic artery. Initial reduction of contents was easy. However, complete reduction proved to be difficult due to adhesions with the sac opening, the hernial sac instead laid open by dividing the Inferior Mesentric Vein (IMV) (anterior border of defect) using a vascular stapler. The patient was discharged on postoperative day 3 in a stable condition. On follow-up the patient is doing well.
一位 30 岁男性因绞痛性腹痛就诊，病程 2 个月，伴有偶尔的胆汁性呕吐。他在 16 岁和 26 岁时有过类似的症状。腹部增强 CT 符合左侧十二指肠旁疝的诊断。腹腔镜检查发现左侧十二指肠旁窝（兰氏窝）有 3×3cm 的疝缺损。内容物为空肠和近端回肠，扩张和水肿。疝囊的前边界由肠系膜下静脉和左结肠动脉左支形成。内容物的初步复位很容易，但由于与疝口的粘连，完全复位较为困难，于是使用血管吻合器横断肠系膜下静脉（IMV）（缺损前缘），从而打开疝囊。患者术后第 3 天出院，病情稳定。随访时，患者情况良好。
