PDF(Pubmed)
Abstract：
BACKGROUND: Compared with open mesh repair, transabdominal preperitoneal (TAPP) hernioplasty results in less chronic postoperative inguinal pain and faster postoperative recovery. However, it may still lead to rare but serious complications. Here we report a case of intestinal volvulus with recurrent abdominal pain as the only clinical symptom, which occurred 3 mo after TAPP repair for bilateral inguinal hernia.
METHODS: A 50-year-old male patient underwent laparoscopic TAPP for bilateral inguinal hernias. After the operation, he experienced recurring pain in his lower right abdomen around the surgical area, which was relieved after symptomatic treatment. Three months after the surgery, the abdominal pain became severe and was aggravated over time. The whirlpool sign of the mesentery was seen on contrast-enhanced computed tomography (CT). Laparoscopic exploration confirmed that a barb of the V-Loc™ suture penetrated the peritoneum, which caused the adhesion of the small intestinal wall to the site of peritoneal injury, forming intestinal volvulus. Since there was no closed-loop obstruction or intestinal ischemia, recurrent abdominal pain became the only clinical manifestation in this case. After laparoscopic lysis of adhesions and reduction of intestinal volvulus, the patient recovered and was discharged.
CONCLUSIONS: The possibility of intestinal volvulus should be considered in patients who experience recurrent abdominal pain following TAPP surgery during which barbed V-Loc sutures are used for closing the peritoneum. Contrast-enhanced CT and active laparoscopic exploration can confirm the diagnosis and prevent serious complications.
METHODS: A 50-year-old male patient underwent laparoscopic TAPP for bilateral inguinal hernias. After the operation, he experienced recurring pain in his lower right abdomen around the surgical area, which was relieved after symptomatic treatment. Three months after the surgery, the abdominal pain became severe and was aggravated over time. The whirlpool sign of the mesentery was seen on contrast-enhanced computed tomography (CT). Laparoscopic exploration confirmed that a barb of the V-Loc™ suture penetrated the peritoneum, which caused the adhesion of the small intestinal wall to the site of peritoneal injury, forming intestinal volvulus. Since there was no closed-loop obstruction or intestinal ischemia, recurrent abdominal pain became the only clinical manifestation in this case. After laparoscopic lysis of adhesions and reduction of intestinal volvulus, the patient recovered and was discharged.
CONCLUSIONS: The possibility of intestinal volvulus should be considered in patients who experience recurrent abdominal pain following TAPP surgery during which barbed V-Loc sutures are used for closing the peritoneum. Contrast-enhanced CT and active laparoscopic exploration can confirm the diagnosis and prevent serious complications.
摘要：
背景：与开放网格修复相比，经腹腹膜前（TAPP）疝修补术可减少慢性术后腹股沟疼痛，加快术后恢复。然而,它仍然可能导致罕见但严重的并发症。在这里，我们报告一例肠扭转以反复腹痛为唯一临床症状，发生在TAPP修复双侧腹股沟疝后3个月。
方法：一名50岁男性患者接受腹腔镜TAPP治疗双侧腹股沟疝。手术后,他在手术区域的右下腹部反复疼痛，对症治疗后缓解。手术三个月后,腹痛变得严重，并随着时间的推移而加重。在对比增强计算机断层扫描（CT）上可以看到肠系膜的漩涡状。腹腔镜探查证实V-Loc™缝合线倒钩穿透腹膜，导致小肠壁与腹膜损伤部位粘连，形成肠扭转.由于没有闭环阻塞或肠缺血，复发性腹痛成为这种情况下唯一的临床表现。在腹腔镜下粘连松解术和肠扭转减少后，病人康复出院。
结论：TAPP手术后出现复发性腹痛的患者应考虑肠扭转的可能性，在TAPP手术期间使用带刺V-Loc缝线闭合腹膜。增强CT和主动腹腔镜探查可以明确诊断并预防严重并发症。
方法：一名50岁男性患者接受腹腔镜TAPP治疗双侧腹股沟疝。手术后,他在手术区域的右下腹部反复疼痛，对症治疗后缓解。手术三个月后,腹痛变得严重，并随着时间的推移而加重。在对比增强计算机断层扫描（CT）上可以看到肠系膜的漩涡状。腹腔镜探查证实V-Loc™缝合线倒钩穿透腹膜，导致小肠壁与腹膜损伤部位粘连，形成肠扭转.由于没有闭环阻塞或肠缺血，复发性腹痛成为这种情况下唯一的临床表现。在腹腔镜下粘连松解术和肠扭转减少后，病人康复出院。
结论：TAPP手术后出现复发性腹痛的患者应考虑肠扭转的可能性，在TAPP手术期间使用带刺V-Loc缝线闭合腹膜。增强CT和主动腹腔镜探查可以明确诊断并预防严重并发症。
