胃切除术后传入袢嵌顿至缝合闭合的肠系膜缺损并行Billroth-II重建:2例报告。

IF 0.7 Q4 SURGERY
Surgical Case Reports Pub Date : 2025-01-01 Epub Date: 2025-05-29 DOI:10.70352/scrj.cr.25-0167
Kiyotomi Maruyama, Tadaaki Shimizu, Kou Shimada, Arano Makino, Natsuhiro Morita, Tasuku Kawaguchi, Takahiro Amano, Tomoki Shirota, Kuniyuki Gomi, Motohiro Mihara
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引用次数: 0

摘要

简介:腹内疝是Roux-en-Y、Billroth-II或双胃道重建腹腔镜胃切除术后的重要并发症。建议关闭肠系膜缺损以防止内疝。我们报告了两例发生内疝的患者,其中Billroth-II重建的传入环被嵌顿到闭合的肠系膜缺陷中。病例介绍:一名40多岁男性,因胃癌3个月前行腹腔镜远端胃切除术,术后行Billroth-II重建,肠系膜缺损缝合闭合。患者来我院就诊,主诉上腹部突然剧烈疼痛,诊断为嵌顿性内疝并发急性胰腺炎引起的传入袢梗阻。入院当天进行急诊手术,解除肠嵌顿,未发现肠缺血。然而,术后发生十二指肠微穿孔,使治疗困难。一名70多岁的妇女因胃癌7天前行腹腔镜远端胃切除术,随后行Billroth-II重建,将肠系膜缺损缝合闭合。患者主诉恶心,无腹痛,诊断为内嵌顿疝引起的传入袢阻塞。同日行急诊手术,解除肠嵌顿,未发现肠缺血。病人顺利出院了。在这两个病例中,在Treiz韧带区域形成一个疝口,传入袢被嵌顿到闭合的肠系膜缺损中。结论:嵌顿性内疝应尽早治疗。虽然在Billroth-II重建后需要关闭肠系膜缺损以防止内疝,但肠系膜缺损应在尽可能远离Treiz韧带的左侧关闭。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Incarceration of the Afferent Loop into the Sutured Closed Mesenteric Defect after Gastrectomy Followed by Billroth-II Reconstruction for Gastric Cancer: Two Case Reports.

Introduction: Internal hernia is a critical complication after laparoscopic gastrectomy with Roux-en-Y, Billroth-II or double tract reconstruction. It is recommended that mesenteric defects should be closed to prevent internal hernias. We reported two patients who developed internal hernias, in which the afferent loop of Billroth-II reconstruction became incarcerated into the closed mesenteric defects.

Case presentation: A man in his late 40s had undergone laparoscopic distal gastrectomy 3 months prior for gastric cancer followed by Billroth-II reconstruction, in which mesenteric defect was sutured closed. The patient visited our hospital complaining of sudden severe upper abdominal pain and was diagnosed with afferent loop obstruction due to an incarcerated internal hernia complicated by acute pancreatitis. Emergency surgery, in which intestinal incarceration was relieved and intestinal ischemia was not found, was performed on the same day as admission. However, postoperative duodenal microperforation occurred, making treatment difficult. A woman in her late 70s had undergone laparoscopic distal gastrectomy 7 days prior for gastric cancer followed by Billroth-II reconstruction, in which mesenteric defect was sutured closed. The patient complained of nausea without abdominal pain and was diagnosed with afferent loop obstruction due to an incarcerated internal hernia. Emergency surgery, in which intestinal incarceration was relieved and intestinal ischemia was not found, was performed on the same day. The patient was discharged uneventfully. In both cases, a hernia orifice formed in the Treiz ligament area, and the afferent loop was incarcerated into the closed mesenteric defect.

Conclusions: Incarcerated internal hernias should be treated as soon as possible. Although closure of the mesenteric defects after Billroth-II reconstruction is necessary to prevent internal hernias, mesenteric defects should be closed on the left side as far away from the Treiz ligament as possible.

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