Mesocolic hernia following retroperitoneal laparoscopic radical nephrectomy: A case report
Mesocolic hernia following retroperitoneal laparoscopic radical nephrectomy: A case report
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DOI：
10.1016/j.ijscr.2019.07.040
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发表时间：
2019-01-01
影响因子：
0.6
通讯作者：
Akagi, Yoshito
中科院分区：
文献类型：
--
作者：
Yoshida, Naohiro;Fujita, Fumihiko;Akagi, Yoshito
前言：后腹膜后腹腔镜肾切除术(RLN)后，因肠系膜内疝引起的小肠梗阻(SBO)非常罕见。病例预告：一位66岁男性因左肾盆腔癌行后腹膜后腹膜切除术式膀胱袖带切除后行RLN。术后反复发生SBO。对比剂增强的计算机断层扫描(CT)和经长管胃移植物收缩X线片显示内疝通过结肠系膜到达切除的左肾所在的腹膜后间隙。我们进行了随后的手术治疗内疝。术后6个月无复发。讨论：在RLN过程中，当结肠内侧移位，肾脏正从腹膜后分离时，可能会不经意地造成肠系膜缺陷，导致内疝。切除肾脏会导致一个潜在的腹膜后间隙，小肠可以迁移到那里。虽然在后腹膜入路中没有绝对必要的结肠移位，但在腹膜后间隙仍有直接造成结肠系膜缺损的风险。结论：手术需要有足够的腹膜后筋膜解剖知识和谨慎的手术技巧。术中缝合肠系膜缺损区是预防RLN术后发生内疝的关键。同样重要的是，当患者在肾切除术后出现SBO症状时，应怀疑是内疝，并及时进行适当的检查。(C)2019年提交人(S)。爱思唯尔有限公司代表ijs出版集团有限公司出版。
INTRODUCTION: Small bowel obstruction (SBO) caused by an internal hernia through a mesocolon after retroperitoneal laparoscopic nephrectomy (RLN) is rare.PRESENTATION OF CASE: A 66-year-old man who had undergone RLN with bladder cuff excision for a left renal pelvic cancer. After the surgery, he experienced SBO repeatedly. Contrast-enhanced computed tomography (CT) and gastrografin contract radiography through a long tube showed an internal hernia through the mesocolon to the retroperitoneal space where the resected left kidney had been located. We performed a subsequent surgery for the internal hernia. Postoperative course was uneventful and currently he has no recurrence of herniation 6 months post-operatively.DISCUSSION: Mesenteric defects that cause an internal hernia can be created inadvertently during RLN when the colon is mobilized medially, and the kidney is being detached from retroperitoneum. The removal of a kidney leads to a potential retroperitoneal space to which small intestine can migrate. While there is no absolute necessity in mobilizing the colon during the retroperitoneal laparoscopic approach, there is still a risk of making mesocolic defects directly in the retroperitoneal space.CONCLUSION: We need to perform operations with sufficient anatomical knowledge of retroperitoneal fascia and careful surgical techniques. The critical thing to prevent an internal hernia following RLN is to close the mesenteric defects intraoperatively. It is also important to suspect an internal hernia and do proper examinations promptly when patients had the symptoms of SBO after nephrectomy. (C) 2019 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.