Surgery, Spital Männedorf AG, Maennedorf, Switzerland
Surgery, Spital Männedorf AG, Maennedorf, Switzerland.
BMJ Case Rep. 2022 Apr 7;15(4):e249468. doi: 10.1136/bcr-2022-249468.
Two patients with a laparoscopic resection of the sigmoid colon in their surgical history were diagnosed with an internal hernia because of a mesenteric gap underneath the descending neocolon. While the first case demonstrated a strongly symptomatic patient with a closed-loop obstruction of the small bowel, the second case was less obvious and correct diagnosis was achieved after a few weeks by finally performing a diagnostic laparoscopy. Since internal hernias after laparoscopic sigmoid resection are a rare complication and as presented in the second case can display very unspecific symptoms, the surgeon's awareness is not immediately raised towards it. Therefore, an asymptomatic internal hernia bears a constant risk of a life-threatening outcome allowing to recommend an initial closure of the mesenteric gap. In both cases, successful treatment was achieved by surgery and intraoperatively closing the remaining mesenteric gap. Subsequently recovery and follow-up were uneventful.
两名患者均有腹腔镜乙状结肠切除术病史，因降结肠系膜下存在系膜裂孔而被诊断为内疝。其中第一例患者表现为小肠闭袢性梗阻的症状性强的患者，而第二例患者则不明显，最终通过诊断性腹腔镜检查在数周后才得出正确诊断。由于腹腔镜乙状结肠切除术后的内疝是一种罕见的并发症，且如第二例病例所示，其表现非常不典型，因此外科医生不会立即意识到这种并发症。因此，无症状的内疝存在危及生命的风险，建议对其进行预防性缝合。在这两种情况下，均通过手术成功治疗，并在术中关闭剩余的系膜裂孔。随后患者均恢复良好，随访无异常。
