Internal Hernia Presenting as Obstructive Jaundice
Internal Hernia Presenting as Obstructive Jaundice
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内疝表现为梗阻性黄疸
DOI：
10.1080/00365520310000555
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发表时间：
2003
影响因子：
1.9
通讯作者：
Myron D. Jones
中科院分区：
文献类型：
--
作者：
M.D. J. E. Losanoff;M. Richman;Myron D. Jones
致编辑：我们饶有兴趣地阅读了Joo等人最近发表的关于以梗阻性黄疸和急性胰腺炎为表现的内疝的文章（1）。小囊疝，包括Joo博士小组讨论的温斯洛疝孔，根据其解剖进入区域分为四种类型：通过大网膜、小网膜、横结肠系膜和温斯洛孔的疝均导致小囊肠突出[2]。后一种疝是最罕见的，1997年报道了164例（3），占所有内疝的4.65%至8.55%，占所有肠梗阻的0.38%至4.1%（3）。Joo等人得出结论，梗阻性黄疸和急性胰腺炎是以前未报告的腹内疝并发症，特别是通过温斯洛孔的腹内疝（1）。虽然急性胰腺炎可能如此，但梗阻性黄疸并发腹内疝并非未知。1991年Tjandra和Collier报道了第三例温斯洛孔疝引起的梗阻性黄疸（1）。Joo及其同事强调了诊断内疝的困难，特别是温斯洛孔疝，并建议CT不能区分各种内疝类型（1）。Stewart在20世纪60年代描述了与小囊疝一致的放射学表现，包括：1）上腹部膨胀的肠拥挤在一起，失去活动性，好像在一个袋子里; 2）小囊区域的气体-液体水平; 3）上腹部圆形气体积聚，除了胃的气体阴影; 4）胃向左移位; 5）胃轮廓受压和变形，对应于较小的囊块; 6）肠梗阻体征（2）。将腹部高处的气体阴影识别为胃中的空气以外的东西被认为是基本的
TO THE EDITOR: We read with interest the recent article by Joo et al. on internal hernia presenting as obstructive jaundice and acute pancreatitis (1). Hernias in the lesser sac, including the foramen of Winslow hernia which Dr. Joo's group discusses, are divided into four types depending on their anatomic entry area: hernias through the greater omentum, lesser omentum, transverse mesocolon and foramen of Winslow all lead to intestinal protrusion in the lesser sac (2). The latter hernia is the rarest, with 164 cases described in 1997 (3), representing 4.65 to 8.55% of all internal hernias and 0.38 to 4.1% of all intestinal obstructions (3). Joo et al. conclude that obstructive jaundice and acute pancreatitis are previously unreported complications of internal hernias, particularly those through the foramen of Winslow (1). While this might be so with acute pancreatitis, obstructive jaundice complicating internal hernias is not unknown. Tjandra & Collier reported the third case of obstructive jaundice due to foramen of Winslow hernia in 1991 (1).Joo and colleagues emphasize the difŪculties in making the diagnosis of internal hernia, particularly that of foramen of Winslow hernia, and suggest that CT cannot distinguish between the various internal hernia types (1). The radiographic Ūndings consistent with lesser sac hernia have been described by Stewart in the 1960s and include: 1) Distended intestines crowded together in the upper abdomen, with loss of mobility, as if in a bag; 2) gas-Ŋuid levels in the region of the lesser sac; 3) a rounded gas accumulation in the epigastrium, apart from the gas shadow of the stomach; 4) displacement of the stomach to the left; 5) compression and deformity of the gastric contour, corresponding to a lesser sac mass, and 6) signs of intestinal obstruction (2). The recognition of a gas shadow high in the abdomen as something other than air in the stomach is thought to be of fundamental