Single band small bowel obstruction after total gastrectomy: laparoscopic management

A 40-year-old patient underwent a total gastrectomy for cancer. For a couple of weeks, he has suffered from cramp-like abdominal pain that would go away by themselves. He is admitted for an acute intestinal obstruction that also goes away spontaneously. This video shows the laparoscopic management of this small bowel obstruction.

Créer un compte gratuit

l'Université Virtuelle

Google translate

Résumé
Chapitres
Vos Commentaires
Interrogez les Experts

Vous devez vous identifier pour accéder à cette partie du site !

Single band small bowel obstruction after total gastrectomy: laparoscopic management

Authors

D Mutter, J D'Agostino, J Marescaux

Abstract

A 40-year-old patient underwent a total gastrectomy for cancer. For a couple of weeks, he has suffered from cramp-like abdominal pain that would go away by themselves. He is admitted for an acute intestinal obstruction that also goes away spontaneously. This video shows the laparoscopic management of this small bowel obstruction.

Mots-clés

Single band small bowel obstruction after total gastrectomy, laparoscopic management

Type de vidéo

Vidéo chirurgicale

Durée

06'55''

Publication

2010-04

Popularité

Favoris

Favorites Media

Audio

Sous-titres

E-publication

WeBSurg.com, Apr 2010;10(04).
URL: http://www.websurg.com/doi-vd01en2932.htm

Single band small bowel obstruction after total gastrectomy: laparoscopic management

1. Clinical case presentation 00'12''

A 40-year-old patient underwent a total gastrectomy for cancer. For a couple of weeks, he has suffered from cramp-like abdominal pains that would go away by themselves. He is admitted for an acute intestinal obstruction that also goes away spontaneously. A CT-scan is performed, revealing the aspect of a volvulus caused by bands. Due to the patient’s clinical history and despite the fact that the symptoms resolve by themselves, a laparoscopic exploration is decided upon.

2. Abdominal cavity exploration 00'50''

The exploration allows to immediately identify an abdominal loop attached to the anterior abdominal wall. This abdominal loop is isolated from the rest of the abdominal cavity. As systematically done, we explore the entire small bowel. As always, the exploration starts at the last loop, at the level of the caecum.

3. Small bowel exploration 01'12''

The small bowel is unrolled progressively to ensure that this is a unique problem and that there is not a second hidden band that could also be responsible for the symptoms. As the obstruction has cleared, there is little inflammation of the small bowel before and after the obstruction band. We are immediately surprised by the spiral-like rolling up of the small bowel. The latter already looked very suspicious on the CT-scan. At the back of the twist zone, the small bowel is not dilated. At the level of the adhesion on the anterior abdominal wall, there is indeed a 180 degree twist of the intestine. This is particularly clear when looking at the CT-scan in the cine mode. Indeed in this way, the twisting of the vessels is perfectly identifiable. Proximal to the obstacle, the small intestine is dilated and atonic. The small intestine is entirely unrolled up to the transmesocolic passage. We check the small bowel. Again, this is performed to rule out the presence of another band. The small intestine is manipulated in a very careful way to avoid seromuscular lesions as they could lead to a postoperative digestive fistula, which could be a serious complication in this context of obstruction. The dissection stops at the level of the intestine’s transmesocolic passage, which itself is not dilated. The obstruction is therefore clearly situated distally to this area.

4. Band division 03'00''

At this stage of the procedure, we divide the band. As usual, the division is performed away from the loop in contact to the peritoneum and completed with monopolar coagulation. The latter is again performed very carefully and gradually to avoid any serosal lesions. Dense adhesions are often hemorrhagic and the freed area should therefore have its hemostasis checked. The band’s freeing allows to completely eliminate the intestinal volvulus. The postoperative follow-up is straightforward with a rapid return of the digestive activity.