Mehta Sejal, Adgudwar Shashank, Boralkar Saurabh, Banerjee J K
Junior Resident (General Surgery), Bharati Vidyapeeth (Deemed to be) Medical College, Himali Society, Near Mhatre Bridge, Erandwane, Pune, India.
Assistant Professor (General Surgery), Bharati Vidyapeeth (Deemed to be) Medical College, Vantage by Rucha Group, Baner, Pune, India.
Med J Armed Forces India. 2023 Sep-Oct;79(5):593-596. doi: 10.1016/j.mjafi.2021.06.012. Epub 2021 Aug 26.
Gastrojejunostomy without gastric resection is performed to bypass the distal stomach or the duodenum. Gastrojejunal stoma (GJ) obstruction is an unusual complication. Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities or intraoperatively, as the classic features are absent during the first 24 h and even for several days. Symptoms of injury to other intra-abdominal organs or structures commonly mask or supersede that of pancreatic injury, both early and late in the course of trauma. Hence, these injuries are often overlooked. We present a case of gastrojejunal stoma obstruction after a primary repair of traumatic American Association for the Surgery of Trauma" (AAST) grade IV duodenal injury. The surgery included repair of the duodenum over a T-tube, a pyloric occlusion, a retrocolic loop gastrojejunostomy, and feeding jejunostomy. And thereafter, successful management of postoperative complication with adhesiolysis, necrosectomy, and revised antecolic isoperistaltic Roux-en-Y gastrojejunostomy for retrocolic GJ stoma obstruction due to post-traumatic pancreatitis.
不进行胃切除的胃空肠吻合术用于绕过胃远端或十二指肠。胃空肠吻合口(GJ)梗阻是一种罕见的并发症。胰腺损伤通常难以通过不同的诊断成像方式或术中识别,因为在最初24小时甚至数天内都没有典型特征。在创伤过程的早期和晚期,其他腹腔内器官或结构损伤的症状通常会掩盖或取代胰腺损伤的症状。因此,这些损伤常常被忽视。我们报告一例在对创伤性美国创伤外科协会(AAST)IV级十二指肠损伤进行一期修复后发生胃空肠吻合口梗阻的病例。手术包括经T管修复十二指肠、幽门闭塞、结肠后袢式胃空肠吻合术和空肠造口术。此后,通过粘连松解术、坏死组织切除术成功处理了术后并发症,并针对结肠后GJ吻合口因创伤后胰腺炎导致的梗阻,修订为结肠前顺蠕动Roux-en-Y胃空肠吻合术。