模仿乙状结肠造口术末端脱垂的造口嵌顿小肠疝。

IF 0.5 Q4 GASTROENTEROLOGY & HEPATOLOGY Case Reports in Gastroenterology Pub Date : 2024-01-19 eCollection Date: 2024-01-01 DOI:10.1159/000535988
Kaoru Abe, Daisuke Yamai, Chihiro Katsumi, Manabu Oyamatsu, Kenji Sato
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引用次数: 0

摘要

介绍:造口脱垂很容易通过肉眼检查确诊,而且很少发生嵌顿。因此,一旦确诊,通常会立即进行人工减张术。在本报告中,我们描述了一例造口脱垂病例,由于造口内发生了嵌顿性旁疝,模仿造口脱垂而无法进行人工减张并导致破裂:一位 66 岁的妇女因子宫内膜癌伴有直肠浸润而接受了全子宫切除术、双侧输卵管切除术、盆腔和主动脉旁淋巴结切除术、卵巢切除术、播散切除术和低位前切除术,并形成乙状结肠造口。初次手术后 14 个月,她出现造口脱垂和多次呕吐。脱垂的造口长 20 厘米,看起来肿胀、水肿,而且有些坚硬。虽然看起来还活着,但部分粘膜呈暗红色,表明有充血现象。因此,诊断结果是乙状结肠末端造口脱垂,并伴有缺血成分。尝试用手将结肠切除后发现结肠破裂,于是进行了紧急开腹手术。术中,我们发现回肠嵌顿在结肠造口形成的孔道中。松开嵌顿的回肠后,造口脱垂就很容易缩小了。结肠造口末端在左上腹重新成形:结论:腹腔旁疝嵌顿可模拟造口脱垂。如果检查结果与典型的造口脱垂不同,则应进行造影检查,以确认造口脱垂是否涉及其他临床实体。
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Incarcerated Small Bowel Herniation in a Stoma Mimicking Sigmoid End Colostomy Prolapse.

Introduction: A stoma prolapse is easy to diagnose by visual examination, and it rarely incarcerates. Therefore, manual reduction is usually performed as soon as the diagnosis is made. In this report, we describe a case of stoma prolapse that could not be reduced manually and ruptured because an incarcerated parastomal hernia occurred in the stoma, mimicking stoma prolapse.

Case presentation: A 66-year-old woman underwent total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, omentectomy, resection of dissemination, and low anterior resection with formation of a sigmoid end colostomy for endometrial cancer with infiltration of the rectum. Fourteen months after the initial operation, she presented with stoma prolapse and multiple episodes of vomiting. The prolapsed stoma was 20 cm in length, appeared swollen and edematous, and was somewhat firm. Although it looked viable, some of the mucosa was darkish red, indicating congestion. Therefore, the diagnosis was sigmoid end colostomy prolapse with an ischemic component. An attempt at manual reduction resulted in rupture, so an emergency laparotomy was performed. Intraoperatively, we found that the ileum was incarcerated in the aperture created where the colostomy had been formed. When the incarcerated ileum was released, the stoma prolapse could be reduced easily. The end colostomy was refashioned in the left upper quadrant of the abdomen.

Conclusion: An incarcerated parastomal hernia can mimic stoma prolapse. If the findings differ from those of typical stoma prolapse, imaging should be performed to confirm whether another clinical entity is involved in the stoma prolapse.

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来源期刊
Case Reports in Gastroenterology
Case Reports in Gastroenterology Medicine-Gastroenterology
CiteScore
1.10
自引率
0.00%
发文量
99
审稿时长
7 weeks
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