急性小肠梗阻左侧十二指肠旁疝的腹腔镜治疗

An 43-year-old man who was suffering from a intermittent mesogastric and ipogastric pain was admitted to the hospital for further examination.

The results of laboratory tests performed upon admission were normal. CT Scan revealed an encapsulated circumscribed cluster of jejunal loops in the left upper quadrant. The proximal side of the cluster was shown to be the jejunum near the ligament of Treitz, and the hernia orifice was adjacent to the left side of the superior mesenteric artery and vein. The endovenous contrast medium showed the so- called perfusion cut-off sign that define a midgut volvolus. No dilatation of the jejunum was observed. These radiologic findings suggested an internal hernia of some kind and a paraduodenal hernia with volvulus was the most likely.

Emergent laparoscopic surgery was performed to treat the internal hernia. Three ports were placed on the abdominal wall (right lumbar region, right hypochondriac and right iliac fossa).
During laparoscopy the small bowel was found completely herniated under the mesenteric vessel. After the adhesiotomy, the jejunum entrapped in the hernia was gradually reduced and examinated.
There was nor apparent abnormality of the transverse or descending colon nor visible hernia sac Then the hernia space was simply closed with a running barbed V-Lok suture.

                               
登录/注册后可看大图

The patient was discharged 4 days after surgery without complications.