CT Finding of Afferent Loop Obstruction by Retroanastomotic Hernia: A Case Report

接口後疝造成入向腸段阻塞之CT發現一病例報告

蔡長晃(Chang-Huang Tsai) ； 吳冠群(Koon-Kwan Ng) ； 陳晃洋(Huang-Yang Chen)

《中華放射線醫學雜誌》 28卷2期 (2003/04) Pp. 119-123

摘要

在胃空腸吻合術後，可發生入向腸段阻塞與出向腸段接口後疝，臨床上可出現急性腹痛，乃是外科急症。我們報告一個病例，他是34歲男性，24年前因胃穿孔曾接受胃次切除與胃空腸吻合術。他被送到急診室的主訴是急性腹痛，理學檢查有全腹壓痛，抽血檢查Amylase與Lipase都很高，因此被懷疑有急性胰臟炎。於是送到本科接受腹部CT掃描，CT的影像顯現上腹部局部小腸腫脹，有腸阻塞現象，且高度懷疑有腹內疝現象。後來經過外科的開刀亦證實有入向腸段阻塞與出向腸段接口後疝。其腹部CT的影像令人印象深刻，將可提供給放射診斷科醫師與臨床醫師一些經驗與警覺。

關鍵字

入向腸段 ； 出向腸段 ； 接口後疝 ； 胃空腸吻合術 ； 電腦斷層檢查術

並列摘要

Afferent loop (A-loop) obstruction and efferent loop (E-loop) retroanastomotic hernia is an acute abdominal condition encountered after gastrojejunostomy. We present a case of adult male (34 years old) who received subtotal gastrectomy with gastrojejunstomy 24 years ago, because of perforation of peptic ulcer (PPU). He was admitted to our hospital because of acute abdominal pain.
The laboratory (Lab.) data showed high serum amylase and lipase, and acute pancreatitis was suspected. However abdominal computed tomography (CT scan) revealed regional small bowel dilatation over upper abdomen, suggesting of regional small bowel obstruction and possible internal herniation. Following surgery confirmed that the A-loop was dilated and incarcerated in the retroanastomotic space. The characteristic CT findings will give some experience and awareness for a radiologist or a clinician.

並列關鍵字

Afferent loop ； Efferent loop ； Retroanastomotic hernia ； Gastrojejunostomy ； Computed tomography