背景:腹腔镜Nissen胃底折叠术是治疗严重GERD的有效标准手术方法。虽然它通常是安全有效的,这种手术后可能会发生一种罕见但可能致命的并发症,称为急性胃扭转。
方法:一名28岁男性,腹腔镜Nissen胃底折叠术后10个月,有一天的严重上腹痛病史,腹胀,非生产性的繁殖,呼吸困难.检查显示呼吸急促,皮下肺气肿和腹部扩张。影像学检查显示左侧气胸,气腹,和一个严重膨胀的胃。急诊剖腹探查术证实器轴性胃扭转,弯曲度较大的坏死和胃穿孔。行部分胃切除术和前胃切除术。放置左侧胸廓造口管以引流左侧气胸。他在术后完全恢复,所有症状完全缓解。
结论:腹腔镜Nissen胃底折叠术后急性胃扭转归因于粘连,胃造口管,还有像缝线一样的异物.危及生命的并发症,比如胃穿孔,可以随之而来,强调需要迅速诊断和治疗。
结论:腹腔镜Nissen胃底折叠术后急性胃扭转是一种罕见的情况,而且很难诊断.鉴于在乌干达进行的腹腔镜Nissen胃底并发症的发生率稳步上升,在有这种潜在致命性并发症的患者中,保持较高的怀疑指数对于良好的患者预后至关重要.
BACKGROUND: Laparoscopic Nissen Fundoplication is an effective standard surgical procedure for treatment of severe GERD. While it is generally safe and effective, a rare but potentially fatal complication known as acute gastric volvulus can occur following this procedure.
METHODS: A 28-year-old male, ten months post Laparoscopic Nissen Fundoplication presented with a one-day history of severe epigastric pain, abdominal distention, unproductive retching, and difficulty in breathing. Examination revealed tachypnea, subcutaneous emphysema and a tender distended abdomen. Imaging studies showed a left pneumothorax, pneumoperitoneum, and a grossly distended stomach. Emergency exploratory laparotomy confirmed organoaxial gastric volvulus, necrosis of the greater curvature and gastric perforation. Partial gastrectomy and anterior gastropexy were performed. A left thoracostomy tube was placed to drain the left pneumothorax. He recovered fully post-operatively with complete resolution of all symptoms.
CONCLUSIONS: Acute Gastric volvulus post Laparoscopic Nissen Fundoplication is attributed to adhesions, gastrostomy tubes, and foreign bodies like sutures. Life-threatening complications, such as gastric perforation, can ensue, underscoring the need for swift diagnosis and treatment.
CONCLUSIONS: Acute gastric volvulus following Laparoscopic Nissen Fundoplication is a rare condition, and is difficult to diagnose. Given the steadily increasing rates of laparoscopic Nissen fundoplications performed in Uganda, maintaining a high index of suspicion is crucial for favorable patient outcomes among patients with this potentially fatal complication.