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哈特曼氏回纳术中肠管解剖结构误认后的灾难性后果：一例报告及技术考量

Catastrophic outcome following misidentification of bowel anatomy during Hartmann's reversal: A case report and technical considerations.

作者信息

Almughamsi Asim M

机构信息

Department of Surgery, Taibah University, Medina, Saudi Arabia.

出版信息

Int J Surg Case Rep. 2024 Dec;125:110633. doi: 10.1016/j.ijscr.2024.110633. Epub 2024 Nov 19.

DOI:10.1016/j.ijscr.2024.110633
PMID:39602936
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11638636/
Abstract

BACKGROUND

Reversal of Hartmann's procedure is a complex surgery with potential complications. This case report describes a rare and severe complication following an attempted reversal.

CASE PRESENTATION

A 53-year-old male who had undergone a Hartmann's procedure for non-metastatic sigmoid colon cancer presented with bowel obstruction 10 days after attempted reversal surgery at another hospital. Imaging studies suggested an entero-colic fistula. Emergency laparotomy revealed dense adhesions and multiple bowel injuries. The procedure was terminated, and controlled fistulae were created.

MANAGEMENT AND OUTCOME

The patient required two months of intensive care. A subsequent surgery excised the fistulae and restored intestinal continuity, leaving the patient with an end colostomy and approximately 120 cm of ileum.

CONCLUSION

This case highlights the potential risks of Hartmann's reversal and emphasizes the importance of proper patient selection, timing, and surgical expertise. It underscores the need for thorough preoperative evaluation and preparation when attempting such complex surgeries.

摘要

背景

哈特曼手术的逆转是一项复杂的手术，存在潜在并发症。本病例报告描述了一次逆转尝试后出现的罕见且严重的并发症。

病例介绍

一名53岁男性因非转移性乙状结肠癌接受了哈特曼手术，在另一家医院进行逆转手术后10天出现肠梗阻。影像学检查提示存在肠结肠瘘。急诊剖腹探查发现粘连严重且多处肠损伤。手术终止，并建立了可控性瘘。

治疗与结果

患者需要两个月的重症监护。随后的手术切除了瘘管并恢复了肠道连续性，患者最终保留了末端结肠造口和大约120厘米的回肠。

结论

本病例突出了哈特曼手术逆转的潜在风险，并强调了正确选择患者、把握时机和具备手术专业技能的重要性。它强调了在尝试此类复杂手术时进行全面术前评估和准备的必要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/607b/11638636/8b895a9dcad4/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/607b/11638636/9e835d4974de/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/607b/11638636/b93ca56ac99e/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/607b/11638636/762a385c0a7c/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/607b/11638636/e1c6333b523d/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/607b/11638636/8b895a9dcad4/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/607b/11638636/9e835d4974de/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/607b/11638636/b93ca56ac99e/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/607b/11638636/762a385c0a7c/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/607b/11638636/e1c6333b523d/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/607b/11638636/8b895a9dcad4/gr5.jpg

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