Intestinal infarction by internal hernia in Petersen's space after laparoscopic gastric bypass
Intestinal infarction by internal hernia in Petersen's space after laparoscopic gastric bypass
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DOI：
10.3748/wjg.v20.i43.16349
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发表时间：
2014-11-21
影响因子：
4.3
通讯作者：
Allieta, Rosaldo
中科院分区：
文献类型：
--
作者：
Fabozzi, Massimiliano;Contul, Riccardo Brachet;Allieta, Rosaldo
腹腔镜Roux-en-Y-GBP(LGBP)术后肠内瘘并不少见(0.2%-5%)，与肠系膜血管受累相关的发病率和死亡率较高。本中心自2009年10月至2013年4月，共收治腹内斜疝17例，412侧LGBP，占4.12%。临床病例：28岁女性，体重指数(BMI)49，共病：糖尿病和关节病，10个月前行LGBP手术，反复腹痛，伴有肺泡改变1周。呕吐后，她去了一家外围医院的急救室，在那里她进行了血液检查，腹部X光和US检查，结果正常，因此被诊断为流感样综合征出院。3d后，患者因症状加重与本中心联系并入院治疗。血液检查显示肝酶和淀粉酶改变。腹部计算机断层扫描(CT)显示脾周围、肝周围和盆腔内有液体存在，“靶样影像”的“簇状回肠”和门静脉系膜上静脉(SMV)血栓。在手术过程中，我们发现80厘米的肠梗阻(空肠-空肠吻合口下游约50厘米)由于通过Petersen‘s间隙的内疝导致SMV血栓形成。切除坏死肠，缩小内疝，用不能吸收的流动缝线缝合Petersen‘s间隙。术后开始抗凝治疗，28d后出院。结论：腹内斜疝的诊断很少通过术前检查确诊，多数病例是通过腹腔镜检查获得的，但随着技术的进步和“新的”CT征象解释的发现，对于高度怀疑的病例，可以及早进行腹腔镜治疗。(C)2014百仕登出版集团有限公司，版权所有。
Intestinal occlusion by internal hernia is not a rare complication (0.2%-5%) after Laparoscopic Roux-en-Y-GBP (LGBP) with higher morbidity and mortality related to mesenteric vessels involvement. In our Center, from October 2009 to April 2013 we have had 17 pts treated for internal hernia on 412 LGBP (4.12%). Clinical case: 28-year-old woman, operated of LGBP (BMI = 49; comorbidity: diabetes mellitus and arthropathy) about 10 mo before, was affected by recurrent abdominal pain with alvus alteration lasting for a week. After vomiting, she went to first aid Unit of a peripheric hospital where she made blood tests, RX and US of abdomen that resulted normal so she was discharged with flu like syndrome diagnosis. After 3 d the patient contacted our Center since her symptoms got worse and was hospitalized. Blood tests showed an alteration of hepatic enzymes and amylases. The abdominal computed tomography (CT) showed the presence of fluid in perisplenic, peri-hepatic areas and in pelvis and a "target like imagine" of " clustered ileal loops" with a superior mesenteric vein (SMV) thrombosis involving the Portal Vein. During the operation, we found a necrosis of 80 cm of ileus (about 50 cm downstream the jejuno-jejunal anastomosis) due to an internal hernia through Petersen's space causing a SMV thrombosis. The necrotic bowel was removed, the internal hernia was reduced and Petersen' space was sutured by not-absorbable running suture. An anticoagulant therapy was begun in the post-operative time and the patient was discharged after 28 d. Conclusions: The internal hernia diagnosis is rarely confirmed by preoperative exams and it is obtained in most cases by laparoscopy but the improvement of technologies and the discover of " new" CT signs interpretation can address to an early laparoscopic treatment for high suspicion cases. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.