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급성 장폐색을 일으킨 십이지장주위탈장의 임상분석

Clinical Analysis of an Acute Intestinal Obstruction with a Paraduodenal Hernia

대한외과학회지 v.66 no.06 , 2004년, pp.484 - 489  
김기환, 윤영철, 서학준, 김지일, 안창혁, 진형민, 김정수, 전해명, 임근우

Purpose: A paraduodenal hernia is an uncommon congenital disease that manifests as an intestinal obstruction, which may lead to strangulation and, subsequently, result in gangrene of the intestine. In this retrospective study, 12 paraduodenal hernia cases were evaluated and the clinical prognostic factors investigated.Methods: Paraduodenal hernias leading to intestinal obstructions were noted in 12 patients. The patients were retrospectively evaluated with respect to signs and symptoms. The laboratory and radiological findings, type of operation, time elapsed between the onset of symptoms and laparotomy and postoperative complications and hospital stays were also reviewed. The relationships between clinical factors and outcomes were also statistically evaluated.Results: In our series, postoperative short bowel syndrome was encountered in one patient (case 1) with bowel strangulation, but there were no mortalities. The time elapsed between the onset of symptoms and laparotomy was found to be longer in the patients with strangulation than in those without (6.8 4.5 day versus 4.1 3.6 day). Additionally, the postoperative hospital stay was longer in those patients with strangulation (24.4 11.6 day versus 15.3 7.7 day), but the relationship was not statistically significant (P=0.283 and 0.130, respectively).Conclusion: Since the preoperative diagnosis of a paraduodenal hernia is very difficult, due to the lack of specific signs and symptoms, the postoperative complications can only be decreased with early surgical intervention in those patients with an acute intestinal obstruction. Although the postoperative morbidity and mortality were not correlated with any of the factors evaluated in this study, further study will be needed to evaluate the significance of the time elapsed between the onset of symptoms and a laparotomy as a prognostic factor.

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