背景:我们最近描述了一组称为扭曲袋综合征的症状,很少影响回肠袋患者。在这里,我们提出了一个叙述性的回顾,其中我们描述了诊断,治疗,和预防眼袋扭曲综合征,专注于简单的分类模式。
方法:内窥镜和放射学检查的诊断体征,治疗,并提出了预防策略。
结果:患有包囊扭曲综合征的患者患有三联征的阻塞性症状,不稳定的排便习惯,和可能严重的疼痛,使人衰弱的内脏疼痛,都是在设置机械袋异常。诊断方式包括成像,仔细的膀胱镜检查,功能测试,诊断性腹腔镜检查或剖腹手术,和最近的三维囊图。扭曲袋综合征的分类基于袋及其肠系膜的位置和旋转程度。吻合过程中,当远端囊顺时针旋转>90°至360°时,可能会导致出口扭曲;当只有最远端囊扭曲时,它会导致小袋出口的虹膜状畸形,或者当袋子的远端一半扭曲时,可能会导致中囊狭窄和沙漏形囊。入口扭曲是完整的360°(肠系膜后部),无意180°(肠系膜前),或逆时针扭曲90°。入口和出口扭曲都是固定的畸形,只能通过将整个袋与肛门断开连接来减少。如果它们导致眼袋扭曲综合征,需要重做囊袋手术或囊袋切除以减少扭曲;逆时针旋转90°可能会进行囊袋入口转位。当小袋以异常的构造固定在骨盆中时,会产生粘合剂扭曲。例如,当传出肢体在J泄漏的隐匿性尖端继发的传入肢体下方扭曲时,并且可能通过骨盆粘连松解术减少,有或没有眼袋翻修。
结论:包装袋在施工过程中很少会被无意扭曲,或者由于粘连性疾病或渗漏而扭曲。建立诊断需要高度怀疑。我们提出了扭曲袋综合征的简单分类,这可能有助于预防和识别这些通常难以诊断的术后并发症。
在本文中,我们报告了一个简单的机械性袋并发症分类系统,称为扭曲袋综合征,包括内窥镜和放射学检查的诊断体征,治疗,和预防策略。
BACKGROUND: We recently described a cluster of symptoms known as twisted pouch syndrome that rarely affects patients with ileoanal pouches. Herein, we present a narrative review in which we describe the diagnosis, treatment, and prevention of twisted pouch syndrome, with a focus on a simple classification schema.
METHODS: Diagnostic signs from endoscopic and radiological examinations, treatment, and prevention strategies are presented.
RESULTS: Patients with twisted pouch syndrome suffer from a triad of obstructive symptoms, erratic bowel habits, and pain which may be severe, debilitating visceral pain, all in the setting of a mechanical pouch abnormality. Diagnostic modalities include imaging, careful pouchoscopy, functional testing, diagnostic laparoscopy or laparotomy, and recently 3-dimensional pouchography. Classification of twisted pouch syndrome is based on the location and degree of rotation of the pouch and its mesentery. Outlet twists may result when the distal pouch rotates >90° to 360° clockwise inadvertently during anastomosis; when only the distal most pouch is twisted, it results in an iris-like deformity of the pouch outlet, or when the distal half of the pouch is twisted, a mid-pouch stenosis and an hourglass-shaped pouch may result. Inlet twists are either a full 360° (mesentery posterior), unintentional 180° (mesentery anterior), or 90° counterclockwise twists. Both inlet and outlet twists are fixed deformities and may only be reduced by disconnecting the entire pouch from the anus. If they result in twisted pouch syndrome, a redo pouch procedure or pouch excision is required to reduce the twist; 90° counterclockwise twists may undergo pouch inlet transposition. Adhesive twists result when the pouch becomes fixed in the pelvis in an abnormal configuration, such as when the efferent limb becomes twisted underneath the afferent limb secondary to an occult tip of the J leak, and may be reduced by pelvic adhesiolysis with or without pouch revision.
CONCLUSIONS: Pouches may rarely be inadvertently twisted during construction or twisted owing to adhesive disease or leaks. A high index of suspicion is needed to establish the diagnosis. We present a simple classification of twisted pouch syndrome that may aid in the prevention and recognition of these often difficult to diagnose postoperative complications.
In this article, we report a simple classification system for the mechanical pouch complication known as twisted pouch syndrome, including diagnostic signs from endoscopic and radiological examinations, treatment, and prevention strategies.