Hernie interne du ligament falciforme r¡§|v¡§|l¡§|e par une occlusion intestinale aigu?

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• 作者：Heykal Bedioui¹ ; ^{h_bdioui@yahoo.fr} ; Amine Daghfous¹ ; Amine Daghfous¹ ; Rachid Ksantini¹ ; Kais Nouira² ; Faouzi Chebbi¹ ; Fadhel Fteriche¹ ; Wael Rebai¹ ; Mohamed Jouini¹ ; Montasser Kacem¹ ; Emna Menif² ; Zoubeir Bensafta¹
• 刊名：La Presse M¡§|dicale
• 出版年：2008
• 出版时间：January 2008
• 年：2008
• 卷：37
• 期：1_part_P1
• 页码：44-47
• 全文大小：1048 K

文摘

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Summary

Introduction

Internal hernias are a rare cause of acute intestinal obstruction. Herniation through the falciform ligament is rare and often diagnosed only during surgery. Abdominal computed tomography (CT), performed on an emergency basis, can help to diagnose this obstruction before surgery and select a therapeutic approach.

Case

A 60-year-old man was hospitalized on an emergency basis for symptoms that had been developing for 3 days, including tympanites and epigastric pain (torsion), associated with vomiting and the cessation of both feces and flatus. Abdominal radiography showed multiple levels of air-fluid levels in the small bowel, some projecting towards the liver area, as well as the presence of a flat intestinal loop continuous with a distended small-bowel segment. Abdominal CT suggested a diagnosis of small-bowel herniation and obstruction, very probably through the falciform ligament. The patient then underwent emergency surgery after a brief resuscitation. Intraoperative exploration confirmed the diagnosis of internal hernia through the falciform ligament. The postoperative course was without problems.

Discussion

Abdominal CT is the examination of choice in cases of a ?¡ãnew?¡À acute intestinal obstruction. It makes it possible to diagnose the mechanism of the occlusion and especially the cause, especially for an internal hernia through the falciform ligament. It thus guides the choice of emergency surgical procedure and of appropriate approach. Once diagnosed, emergency surgery is essential to free the intestinal loop, with or without intestinal resection as a function of vitality.