Wallace Lauren, Gallagher James
Department of General Surgery, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia.
Department of Surgery, Wimmera Base Hospital, Horsham, VIC 3400, Australia.
J Surg Case Rep. 2023 Mar 7;2023(3):rjad103. doi: 10.1093/jscr/rjad103. eCollection 2023 Mar.
Benign anastomotic strictures most commonly occur within 3-12 months after anterior resection (AR) with chronic symptoms amenable to endoscopic treatment. This case describes an acute large bowel obstruction secondary to a severe delayed benign anastomotic stricture in a 74-year-old female who had previously underwent a laparoscopic AR for sigmoid adenocarcinoma 3 years prior. The pathophysiology of benign anastomotic strictures remains poorly understood. This case was likely multifactorial. Potential contributing factors include anastomotic ischaemia and concomitant collagenous colitis, with inflammation leading to fibrosis and stricture development. Surgical techniques to optimize anastomotic vascularity are important to consider, particularly in older patients with multiple co-morbidities.
良性吻合口狭窄最常发生在前路切除术后3 - 12个月内，伴有可通过内镜治疗的慢性症状。本病例描述了一名74岁女性因严重延迟性良性吻合口狭窄继发急性大肠梗阻，该患者3年前曾因乙状结肠癌接受腹腔镜前路切除术。良性吻合口狭窄的病理生理学仍知之甚少。该病例可能是多因素导致的。潜在的促成因素包括吻合口缺血和并发胶原性结肠炎，炎症导致纤维化和狭窄形成。优化吻合口血管供应的手术技术很重要，尤其对于有多种合并症的老年患者。
