■传入环路阻塞(ALO)可作为BillrothII或Roux-en-Y重建胃切除术的并发症发生。传统上,大多数病例都进行了紧急手术,虽然最近有报道对择期病例进行内窥镜检查。我们报告了由植物牛黄引起的ALO的独特病例,该病例已通过内窥镜手术成功治疗。
方法:一名76岁女性患者在晚餐后出现上腹痛数小时。该患者在62岁时有远端胃切除术和Roux-Y重建胃癌的病史。计算机断层扫描(CT)显示十二指肠和胆总管明显扩张,并在空肠空肠吻合部位检测到牛黄,表明ALO是由牛黄诱导的。上内窥镜检查显示吻合部位的未消化食物形成,并且通过使用活检钳的内镜碎片成功地将其移位。手术后,腹部症状消退,患者在第四天出院。
■牛黄诱导的ALO很少见。在这种情况下,CT有助于诊断牛黄引起的ALO。最近,ALO的内窥镜干预措施有所增加,并且有一些报道称牛黄引起的小肠梗阻正在通过内窥镜治疗。因此,随后进行了内窥镜检查,在这种情况下,确认存在植物石,并导致侵入性较小的内窥镜碎片治疗。
结论:这是一个独特的病例报告,通过内窥镜对未消化的食物进行破碎处理,提供有益的治疗选择。
UNASSIGNED: Afferent loop obstruction (ALO) can occur as a complication of gastrectomy with Billroth II or Roux-en-Y reconstruction. Conventionally, emergent surgery was performed for most cases, while endoscopic procedures for elective cases have been reported more recently. We report a unique case of ALO caused by a phytobezoar that was successfully treated by endoscopic procedures.
METHODS: A 76-year-old female patient presented with epigastric pain for several hours after dinner. The patient had a history of distal gastrectomy with Roux-Y reconstruction for gastric cancer at age 62. Computed tomography (CT) demonstrated evident dilation of the duodenum and common bile duct, and detected a bezoar at the jejunojujunal anastomosis site, indicating that the ALO was induced by the bezoar. Upper endoscopy visualized undigested food formation stuck at the anastomosis site, and it was successfully dislodged by endoscopic fragmentation using biopsy forceps. After the procedure, the abdominal symptoms subsided, and the patient was discharged on the fourth day.
UNASSIGNED: Bezoar-induced ALO is rare. In this case, CT helped diagnose the ALO induced by the bezoar. In recent times, there has been a rise in endoscopic interventions for ALO, and there are some reports of bezoar-induced small bowel obstruction being treated endoscopically. Therefore, a subsequent endoscopic examination was performed, confirming the presence of a phytobezoar and leading to a less invasive endoscopic fragmentation treatment in this case.
CONCLUSIONS: This is a unique case report of phytobezoar-induced ALO treated by endoscopic fragmentation of undigested food, providing a beneficial treatment option.