Mare Hans, Tjhin William
General Surgery, Rockingham General Hospital, Rockingham, AUS.
Cureus. 2023 Feb 6;15(2):e34663. doi: 10.7759/cureus.34663. eCollection 2023 Feb.
Management of small bowel obstruction varies depending on the cause and clinical status of patients. While most cases can be managed conservatively, a not-insignificant proportion of patients undergo surgical intervention. Laparotomy has long been the default approach for entering the abdomen in cases requiring surgical intervention, with laparoscopy largely being avoided due to abdominal distension and the risk of perforating bowels on entry. We present here the case of a 54-year-old woman who presented with signs and symptoms as well as radiological evidence of a closed-loop small bowel obstruction in her right lower quadrant. Following a brief period of nasogastric decompression, her abdominal distension improved, allowing for a laparoscopic entry where a pericaecal hernia was noted to be the cause of her obstruction. Extensive adhesiolysis without the use of an energy device successfully allowed for the reduction of the bowel contained within. No bowel resection was performed and the patient was discharged home on day 3 following her procedure. This case report successfully demonstrates the utility of using laparoscopy as an alternative to laparotomy in patients with a small bowel obstruction secondary to an internal hernia.
小肠梗阻的治疗方法因患者的病因和临床状况而异。虽然大多数病例可以保守治疗，但仍有相当一部分患者需要接受手术干预。长期以来，剖腹手术一直是需要手术干预时进入腹腔的默认方法，由于腹胀和进入时肠穿孔的风险，腹腔镜检查在很大程度上被避免。我们在此介绍一名54岁女性的病例，她出现了右下象限闭环性小肠梗阻的体征和症状以及影像学证据。经过短暂的鼻胃减压后，她的腹胀有所改善，从而可以进行腹腔镜检查，发现盲肠周围疝是其梗阻的原因。在不使用能量装置的情况下进行广泛的粘连松解术，成功地使肠内容物复位。未进行肠切除术，患者在手术后第3天出院回家。本病例报告成功证明了腹腔镜检查作为内疝继发小肠梗阻患者剖腹手术替代方法的实用性。
