PDF(Pubmed)
Abstract：
BACKGROUND: The majority of small bowel obstructions (SBO) are caused by adhesion due to abdominal surgery. Internal hernias, a very rare cause of SBO, can arise from exposed blood vessels and nerves during pelvic lymphadenectomy (PL). In this report, we present two cases of SBO following laparoscopic and robot-assisted lateral lymph node dissection (LLND) for rectal cancer, one case each, of which obstructions were attributed to the exposure of blood vessels and nerves during the procedures.
METHODS: Case 1: A 68-year-old man underwent laparoscopic perineal rectal amputation and LLND for rectal cancer. Four years and three months after surgery, he visited to the emergency room with a chief complaint of left groin pain. Computed tomography (CT) revealed a closed-loop in the left pelvic cavity. We performed an open surgery to find that the small intestine was fitted into the gap between the left obturator nerve and the left pelvic wall, which was exposed by LLND. The intestine was not resected because coloration and peristalsis of the intestine improved after the hernia was released. The obturator nerve was preserved. Case 2: A 57-year-old man underwent a robot-assisted rectal amputation with LLND for rectal cancer. Eight months after surgery, he presented to the emergency room with a complaint of abdominal pain. CT revealed a closed-loop in the right pelvic cavity, and he underwent a laparoscopic surgery with a diagnosis of strangulated SBO. The small intestine was strangulated by an internal hernia caused by the right umbilical arterial cord, which was exposed by LLND. The incarcerated small intestine was released from the gap between the umbilical arterial cord and the pelvic wall. No bowel resection was performed. The umbilical arterial cord causing the internal hernia was resected.
CONCLUSIONS: Although strangulated SBO due to an exposed intestinal cord after PL has been a rare condition to date, it is crucial for surgeons to keep this condition in mind.
METHODS: Case 1: A 68-year-old man underwent laparoscopic perineal rectal amputation and LLND for rectal cancer. Four years and three months after surgery, he visited to the emergency room with a chief complaint of left groin pain. Computed tomography (CT) revealed a closed-loop in the left pelvic cavity. We performed an open surgery to find that the small intestine was fitted into the gap between the left obturator nerve and the left pelvic wall, which was exposed by LLND. The intestine was not resected because coloration and peristalsis of the intestine improved after the hernia was released. The obturator nerve was preserved. Case 2: A 57-year-old man underwent a robot-assisted rectal amputation with LLND for rectal cancer. Eight months after surgery, he presented to the emergency room with a complaint of abdominal pain. CT revealed a closed-loop in the right pelvic cavity, and he underwent a laparoscopic surgery with a diagnosis of strangulated SBO. The small intestine was strangulated by an internal hernia caused by the right umbilical arterial cord, which was exposed by LLND. The incarcerated small intestine was released from the gap between the umbilical arterial cord and the pelvic wall. No bowel resection was performed. The umbilical arterial cord causing the internal hernia was resected.
CONCLUSIONS: Although strangulated SBO due to an exposed intestinal cord after PL has been a rare condition to date, it is crucial for surgeons to keep this condition in mind.
摘要：
背景：大多数小肠梗阻（SBO）是由腹部手术引起的粘连引起的。内疝,SBO的一个非常罕见的原因，可能是由于盆腔淋巴结清扫术（PL）期间暴露的血管和神经引起的。在这份报告中,我们目前的SBO后腹腔镜和机器人辅助的外侧淋巴结清扫术（LLND）的直肠癌，每个一个案例,其中阻塞归因于手术过程中血管和神经的暴露。
方法：病例1：一名68岁男子因直肠癌行腹腔镜会阴直肠截肢术和LLND术。手术四年零三个月后,他带着左腹股沟疼痛的主要投诉去了急诊室。计算机断层扫描（CT）显示左盆腔有闭环。我们做了一个开放的手术，发现小肠被安装在左闭孔神经和左骨盆壁之间的间隙中，这是LLND曝光的。未切除肠，因为在疝释放后，肠的着色和蠕动得到改善。闭孔神经被保留。案例2：一名57岁的男子因直肠癌接受了LLND的机器人辅助直肠截肢术。手术八个月后,他向急诊室提出了腹痛的投诉。CT显示右盆腔有闭环,他接受了腹腔镜手术，诊断为绞窄SBO。小肠是由右脐动脉引起的内部疝绞死的，这是LLND曝光的。嵌顿的小肠从脐动脉索和骨盆壁之间的间隙释放。未进行肠切除术。切除引起内疝的脐动脉索。
结论：尽管由于PL后暴露的肠索而绞窄的SBO迄今为止是一种罕见的疾病，对于外科医生来说，记住这种情况是至关重要的。
方法：病例1：一名68岁男子因直肠癌行腹腔镜会阴直肠截肢术和LLND术。手术四年零三个月后,他带着左腹股沟疼痛的主要投诉去了急诊室。计算机断层扫描（CT）显示左盆腔有闭环。我们做了一个开放的手术，发现小肠被安装在左闭孔神经和左骨盆壁之间的间隙中，这是LLND曝光的。未切除肠，因为在疝释放后，肠的着色和蠕动得到改善。闭孔神经被保留。案例2：一名57岁的男子因直肠癌接受了LLND的机器人辅助直肠截肢术。手术八个月后,他向急诊室提出了腹痛的投诉。CT显示右盆腔有闭环,他接受了腹腔镜手术，诊断为绞窄SBO。小肠是由右脐动脉引起的内部疝绞死的，这是LLND曝光的。嵌顿的小肠从脐动脉索和骨盆壁之间的间隙释放。未进行肠切除术。切除引起内疝的脐动脉索。
结论：尽管由于PL后暴露的肠索而绞窄的SBO迄今为止是一种罕见的疾病，对于外科医生来说，记住这种情况是至关重要的。
