Bensaad Ahmed, Ghaddou Youssef, Nouri Abdelah, Fadil Abdelaziz, Sair Khalid
General Surgery, Cheikh Khalifa International University Hospital, Casablanca, MAR.
Surgery, Cheikh Khalifa International University Hospital, Casablanca, MAR.
Cureus. 2022 Jun 20;14(6):e26124. doi: 10.7759/cureus.26124. eCollection 2022 Jun.
Volvulus of the sigmoid is a common cause of intestinal obstruction in Morocco. It is a serious condition with substantial mortality. Initial endoscopic decompression followed by resection of the redundant colon via laparotomy or laparoscopy is the procedure of choice. Exteriorization of the sigmoid colon through a linear skin incision in the left iliac fossa has been described as an alternative approach for the classic midline incision, with or without laparoscopic assistance, with acceptable results.
We describe herein a novel, minimally invasive approach for fit patients with non-complicated volvulus sigmoid. This approach consists of a skin-disk incision in the left iliac fossa, exteriorization of the redundant colon, and resection with or without primary anastomosis, followed by a purse-string closure.
A 65-year-old patient with no prior notable medical history, presented to the emergency department with his first episode of sigmoid volvulus. A skin-disk incision was made in the left iliac fossa, exteriorization of the sigmoid was done easily through the incision, and resection and manual anastomosis were done. The closure was made in a purse-string fashion. Recovery was uneventful and the patient was discharged home on the fourth postoperative day. No wound infection was noted and the cosmetic result was satisfactory.
Left iliac skin-disk incision followed by a purse-string closure is an option for approaching the abdomen in the case of sigmoid volvulus. It has been demonstrated that this technique helps reduce wound-related complications in patients undergoing stoma reversal. Authors suggest that cosmetic results are better and the incidence of surgical site infection can be lower with this technique as compared to the classic linear skin incision. Results, however, should be confirmed by larger studies.
乙状结肠扭转是摩洛哥肠梗阻的常见病因。它是一种严重疾病，死亡率较高。首选的治疗方法是先进行内镜减压，然后通过剖腹手术或腹腔镜手术切除冗余结肠。经左髂窝线性皮肤切口将乙状结肠外置已被描述为经典中线切口的替代方法，可在有或无腹腔镜辅助的情况下进行，效果尚可。
我们在此描述一种针对非复杂性乙状结肠扭转的适合患者的新型微创方法。该方法包括在左髂窝做一个皮肤盘状切口，将冗余结肠外置，然后进行切除，可进行或不进行一期吻合，随后进行荷包缝合。
一名65岁、既往无显著病史的患者因首次发生乙状结肠扭转而就诊于急诊科。在左髂窝做了一个皮肤盘状切口，通过该切口很容易将乙状结肠外置，然后进行了切除和手工吻合。采用荷包缝合方式进行关闭。恢复过程顺利，患者术后第四天出院。未发现伤口感染，美容效果令人满意。
左髂窝皮肤盘状切口加荷包缝合是乙状结肠扭转时进入腹腔的一种选择。已证明该技术有助于减少造口回纳患者的伤口相关并发症。作者认为，与经典的线性皮肤切口相比，该技术的美容效果更好，手术部位感染的发生率可能更低。然而，结果应通过更大规模的研究加以证实。
