Department of Surgery, University of New Mexico Hospital, Albuquerque, NM.
CRSLS. 2021 Mar 1;8(2). doi: 10.4293/CRSLS.2021.00002. eCollection 2021 Apr-Jun.
We report a case of a 21-year-old male who presented with adult-onset dysphagia after previous Nissen fundoplication initially created at age 10.5 months. The patient first presented one year ago to a different hospital, where he underwent extensive workup for his symptomatology. Physiologic tests performed were esophagogastroduodenoscopy (EGD), abdominal ultrasound, hepatobiliary iminodiacetic acid scan, esophageal manometry, and lactulose breath test. The EGD identified stricture at the level of the gastroesophageal junction. The other studies did not reveal other physiologic causes for his symptoms. The patient then presented to our institution, at which time a repeat EGD showed evidence of tight Nissen fundoplication. The patient subsequently underwent laparoscopic exploration, which revealed that the fundoplication had was partially disrupted, herniated, and twisted causing a long-segment distal stricture. To alleviate the patient's presenting symptom of dysphagia as well as prevent possible future reflux, it was decided to convert repair the hernia and revise the Nissen into a partial fundoplication. This was successfully accomplished laparoscopically with subsequent resolution of the patient's symptoms.
我们报告了一例 21 岁男性患者，在 10.5 个月大时接受了 Nissen 胃底折叠术（最初用于治疗婴儿胃食管反流病）后出现成年发病的吞咽困难。该患者一年前曾在另一家医院就诊，当时对其症状进行了广泛的检查。进行的生理测试包括食管胃十二指肠镜检查（EGD）、腹部超声、肝胆碘代氨基酸扫描、食管测压和乳果糖呼气试验。EGD 发现胃食管交界处存在狭窄。其他研究没有发现导致其症状的其他生理原因。然后该患者转至我们医院，再次进行 EGD 检查显示 Nissen 胃底折叠术存在严重狭窄。随后患者进行了腹腔镜探查，发现胃底折叠术部分破裂、疝出并扭曲，导致长段远端狭窄。为了缓解患者的吞咽困难症状并预防可能的未来反流，决定对疝进行修复，并将 Nissen 胃底折叠术改为部分胃底折叠术。该手术成功地通过腹腔镜完成，随后患者的症状得到缓解。
