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Innhaull : smáþarmsstífla gegnum glufu í breiðfellingu legs

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Authors
Valur Þór Marteinsson
Shree Datye
Issue Date
1990-12-01

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Other Titles
Internal herniation through a defect in the broad ligament of the uterus. A case report
Citation
Læknablaðið 1990, 76(10):505-7
Abstract
Internal herniation through a defect in the broad ligament of the uterus is rare. Unless suspected after prior uteropexy, accurate preoperative diagnosis is distinctly uncommon but most patients are admitted with symptoms and clinical signs of acute small bowel obstruction. Such a case of a postoperative defect is presented. The case was complicated by gangrenous small bowel requiring resection. We make sure this to be the first reported case in Iceland of small bowel obstruction with strangulation secondary to a postoperative defect in the broad ligament of the uterus.
Innhaular (hernia interna) eru andstætt ytri haulum sjaldgæfir og vandasamir í greiningu. Þeir geta annað hvort verið aftan lífhimnu (skinu) með eiginlegum haulpoka eða þar sem glufa er innan lífhimnuholsins í netju eða hengi og líffæri því skotist í gegnum (1). Glufa í breiðfellingu legsins (ligamentum latum uteri) gefur möguleika á innhaul og yfirleitt (90% tilfella) festist smáþarmur í glufunni (2). Sjúkdómsmyndin líkist þá bráðri smáþarmsstíflu, en undantekning er ef undirliggjandi orsök greinist fyrir skurðaðgerð. Fylgikvillar eftir aðgerðir eru háðir síðbúinni sjúkdómsgreiningu og hvort um er að ræða drep í þarminum þegar til aðgerðar kemur. Orsakir glufa í breiðfellingu legs eru einungis þekktar hjá sjúklingum sem hafa gengist undir legfestingu (uteropexia) eða lyftingu, þar sem op er gert í fellinguna (2,3)- Hjá öðrum er orsökin óviss, en bent hefur verið á sýkingar og bólgur í innri kynfærum og áverka við meðgöngur og fæðingar (2-4). Hugsanlega er einhver hluti meðfæddur. Við lýsum tilfelli þar sem um var að ræða glufu í breiðfellingu legs eftir legfestingaraðgerð og smáþarmur, sem lá í kreppu, var brottnuminn. Þetta er fyrsta tilfelli sinnar tegundar á Íslandi.
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