背景:乙状结肠扭转(SV)是一种急性腹部疾病,其特征是乙状结肠在肠系膜周围扭转,并经常导致肠梗阻,可能进展为肠缺血,坏死,或穿孔。尽管SV通常是由于解剖变异等诱发因素而发生的,年龄相关的运动障碍,慢性便秘,和神经系统疾病,其在乙状结肠癌手术后的发病率鲜有报道。在这里,我们报道了一例罕见的腹腔镜乙状结肠切除术后SV复发的病例,通过腹腔镜重做手术成功治疗。
方法:该患者是一名77岁的男性,此前曾接受腹腔镜乙状结肠癌切除术。术后16个月,他在脐带部位出现了切口疝,使用腹膜内嵌网进行腹腔镜修复。疝气手术后,患者在定期随访中没有吻合口漏或狭窄。然而,第一次手术65个月后,他出现了腹痛和腹胀。计算机断层扫描显示残余的乙状结肠在吻合口周围以扭曲的方式扩张,导致SV的诊断。虽然内窥镜去扭转是成功的,SV在2个月后复发,需要择期腹腔镜重做手术。该程序涉及切除乙状结肠,包括先前的左直肠旁切口吻合和使用25毫米圆形吻合器进行DST再吻合。手术持续165min,出血最少,无并发症。术后病程顺利。病理分析证实纤维化无恶性肿瘤。手术后5年以上,患者病情良好,无SV复发和吻合口狭窄。
结论:SV在乙状结肠癌手术后的报道很少。这个案例说明了预防术后SV的潜在需要,尤其是乙状结肠长的患者接受腹腔镜结直肠癌手术。Further,初次腹腔镜结直肠癌手术后的腹腔镜重做手术可以以最小的侵入性进行,特别是如果病人选择管理得当。
BACKGROUND: Sigmoid volvulus (SV) is an acute abdominal condition characterized by torsion of the sigmoid colon around the mesentery, and often results in intestinal obstruction that may progress to bowel ischemia, necrosis, or perforation. Although SV commonly occurs due to predisposing factors like anatomic variations, age-related motility disorders, chronic constipation, and neurologic diseases, its incidence following sigmoid colon cancer surgery has rarely been reported. Herein, we report a rare case of recurrent SV following laparoscopic
sigmoidectomy, which was successfully treated by laparoscopic redo surgery.
METHODS: The patient was a 77-year-old man who had previously undergone laparoscopic
sigmoidectomy for sigmoid colon cancer. Sixteen months postoperatively, he developed an incisional hernia at the umbilical site, which was treated with a laparoscopic repair using an intraperitoneal onlay mesh. After the hernia surgery, the patient had no anastomotic leakage or stenosis on regular follow-ups. However, 65 months after the first surgery, he presented with abdominal pain and distension. A computed tomography revealed that the remnant sigmoid colon was distended in a twisting manner around the anastomosis, leading to the diagnosis of SV. Although endoscopic de-torsion was successful, the SV recurred 2 months later, requiring elective laparoscopic redo surgery. The procedure involved resection of the sigmoid colon including the prior anastomosis with a left pararectal incision and DST re-anastomosis using a 25-mm circular stapler. The operation lasted 165 min with minimal bleeding and no complications. The postoperative course was uneventful. Pathological analysis confirmed fibrosis without malignancy. The patient remains well without recurrence of SV and anastomotic stenosis more than 5 years after surgery.
CONCLUSIONS: SV following sigmoid colon cancer surgery has rarely been reported. This case illustrates the potential need for prophylaxis against postoperative SV, especially in patients with long sigmoid colon undergoing laparoscopic surgery for colorectal cancer. Further, laparoscopic redo surgery following initial laparoscopic surgery for colorectal cancer can be performed with minimal invasiveness, especially if patient selection is properly managed.