Cossu M L, Coppola M, Iannuccelli M, Noya G
General Surgical Clinic, University of Sassari, Italy.
Panminerva Med. 1997 Jun;39(2):141-3.
The aim of this work is to consider the mechanical complications of jejunoileal bypass for morbid obesity which can have a serious outcome because of the occult nature of the symptoms.
The mechanical complications of jejunoileal bypass are mainly intussusception of the bypassed ileal segment, internal herniation of the ileal loops through the mesenteric defects and laparocele.
A recent case is reported in which, most unusually, intussusception and volvulus were both present, with ischaemia and necrosis of the bypassed segment. Moreover, the general health of the patient remains normal despite the severity of the complication.
Examination of blind loop with CT scan which showed an abdominal mass of uncertain interpretation.
A laparotomy revealed a volvulus of bypassed ileal loops, probably caused by a simultaneous ileal intussusception and an adhesion. On account of the extensive nature of the process and the degree of advanced ischaemia and gangrene patches in the folds of the ileum, resection of the entire bypassed segment as far as the previous jejunoileal anastomosis was necessary.
The authors point out the occult nature of the manifestations of this type of complication: aspecific abdominal pains in all quadrants, fever, non vomiting, normal passing of faeces and gas and suggested that simultaneous diverticulitis of the colon (frequently found in the obese) can further complicate and delay diagnosis.
本研究旨在探讨空肠回肠旁路术治疗病态肥胖症时出现的机械性并发症，由于这些症状隐匿，可能会导致严重后果。
空肠回肠旁路术的机械性并发症主要包括旷置回肠段套叠、肠袢通过肠系膜缺损形成内疝以及腹壁疝。
报告了近期一例罕见病例，患者同时出现套叠和肠扭转，伴有旷置肠段缺血坏死。此外，尽管并发症严重，但患者的总体健康状况仍保持正常。
CT扫描检查盲袢，显示腹部有一个难以明确诊断的肿块。
剖腹手术发现旷置肠袢扭转，可能是由于同时发生的回肠套叠和粘连所致。鉴于病变范围广泛以及回肠皱襞处严重的缺血和坏疽斑，有必要切除整个旷置肠段直至先前的空肠回肠吻合处。
作者指出这类并发症表现隐匿：全腹非特异性腹痛、发热、无呕吐、大便和气体排出正常，并提示结肠憩室炎（肥胖者常见）可能会使病情进一步复杂化并延误诊断。
