Khalifa Mohamed Ben, Missaoui Wajdi, Elguedr Wassim, Aouadi Sabri, Maatouk Mohamed, Boudokhane Moez
General Surgery Department, Tahar sfar Hospital Mahdia, Faculty of Medicine, University of Monastir, Tunisia.
General Surgery Department, Tahar sfar Hospital Mahdia, Faculty of Medicine, University of Monastir, Tunisia.
Int J Surg Case Rep. 2025 Feb;127:110977. doi: 10.1016/j.ijscr.2025.110977. Epub 2025 Jan 28.
Small bowel volvulus involves the twisting of an intestinal loop around the axis of its mesenteric attachment. Although rare, it is a potential complication of laparoscopic surgery, and every surgeon should be well aware of it.
We present a case of a 64-year-old patient admitted to our department with acute gastrointestinal obstruction six days after a laparoscopic cholecystectomy. CT showed dilated small intestine with a maximum diameter of 50 mm and a 2 cm subhepatic collection in the gallbladder bed. Emergency open surgery through a midline incision revealed necrosis of the twisted small intestinal loop, necessitating resection, and primary intestinal anastomosis. The postoperative course was uneventful and the patient was discharged on the eighth post-operative day.
Small intestinal volvulus, even not a common complication following laparoscopic cholecystectomy, is nonetheless a serious condition that warrants careful clinical examination and imaging. The mechanism underlying this complication remains unclear; however, a review of similar cases in the English literature highlights several potential contributing factors. These include un-retrieved gallstones, anatomical abnormalities, and prior abdominal surgeries resulting in peritoneal adhesions and notably, in one case adhesions to a metallic clip. Interestingly, concerning our case, the volvulus appeared to result from a loop of bowel rotating around its mesenteric attachment with parietal adhesions acting as a pivot. In addition, we believe that the abscess, despite its 2 cm diameter, may have contributed to the postoperative ileus and thus facilitated the torsion of the small intestine creating a volvulus.
Persistent postoperative abdominal pain and distention should not overshadow the possibility of acute intestinal obstruction after laparoscopy. Delayed diagnosis of bowel volvulus can lead to severe consequences, underscoring the importance of vigilance in postoperative assessments.
小肠扭转是指肠袢围绕其肠系膜附着轴发生扭转。虽然罕见，但它是腹腔镜手术的潜在并发症，每位外科医生都应充分了解。
我们报告一例64岁患者，在腹腔镜胆囊切除术后6天因急性肠梗阻入住我科。CT显示小肠扩张，最大直径为50毫米，胆囊床有一个2厘米的肝下积液。经中线切口进行的急诊开放手术显示扭转的小肠袢坏死，需要进行切除及一期肠吻合术。术后过程顺利，患者在术后第8天出院。
小肠扭转虽是腹腔镜胆囊切除术后不常见的并发症，但仍是一种严重情况，需要仔细的临床检查和影像学检查。这种并发症的潜在机制尚不清楚；然而，对英文文献中类似病例的回顾突出了几个潜在的促成因素。这些因素包括未取出的胆结石、解剖异常以及既往腹部手术导致的腹膜粘连，值得注意的是，在一个病例中与金属夹粘连。有趣的是，就我们的病例而言，扭转似乎是由于一段肠管围绕其肠系膜附着点旋转，而壁层粘连起了支点作用。此外，我们认为，尽管脓肿直径为2厘米，但可能导致了术后肠梗阻，从而促使小肠扭转形成肠扭转。
术后持续的腹痛和腹胀不应掩盖腹腔镜术后急性肠梗阻的可能性。肠扭转的延迟诊断可能导致严重后果，这突出了术后评估中保持警惕的重要性。
