MẠC NỐI VỊ ĐẠI TRÀNG XUẤT PHÁT TỪ BỜ CONG NHỎ DẠ DÀY PHỐI HỢP VỚI DẠ DÀY QUAY DỞ DANG CA LÂM SÀNG BIẾN ĐỔI GIẢI PHẪU DẠ DÀY HIẾM GẶP

Abstract

Aim of study: 1. Evaluate the malformation of  gastrocolic ligament and also gastric malrotation. 2.Literature review of gastric malformation. Patient and method: Retrospective study. Result: Men, 56 years old, admission for gastriccancer and gastric outlet obstruction. + Medical history: alcohol abuse. + Clinic: Epigastric pain and vomitting for 1 month. + Physical examination: No mass palpable, there were abdominal collateral veins in the  anterior wall of abdomen. + Gastroscopy reaveled large antral tumor with pyloric stricture. + Histology: signet ring cell carcinoma. + Abdominal CTScanner: Antral tumor; not found  intra abdominal limph node. + Blood test: Red blood cell counts: 4,75 T/L, Hemoglobin 130 g/L; Hematocrite: 0,39L/L. glomerule: 266 G/L, white blood cell counts 9,0G/L. +Prothrombin 100%; Fibrinogen 1,39 g/L, APTT 28,4s IRN 1.0. + Laboratory finding:Glucose: 4,78 mmol/L, Creatinin 91,73 Mmol/L, AST 26,4 U/L, ALT 19,6U/L, Ure:5,9 Mmol/L. Albumin 41,61 g/L. Plan operation, intra operation lesions: antral tumor measuring 5-6 cm with pyloric stricture. Duodenal ulcer measuring 1,2 cm. There were lymph nods group 1,3,5,6 8a,8p,12a, 12p. Anatomic variation finding: + Tranvesal colon gone up to the small omentum and located behind stomach and duodenum (fig). +Gastrocolic ligament originated from lesser curvature to free border of  transversal colon (fig). + The great omentum was  not attached to transversal colon. + The stomach and D1-D2 đuoenum layed tranversally (fig). - Surgical procedure: Adhesiolysis and subtotal gastrectomy with D2 lymph node dissection. - Histopathologic result: Signet ring cell carcinoma T2N3M0 (11 limph nodes positive/14 havested). Conclusion: The gastric malrotation and malformation as follow: + Tranvesal colon gone up to the small omentum and located behind stomach and  D1-D2 portion of duodenum. +Gastrocolic ligament originated from lesser curvature  to  free border of transvesal colon. + The great omentum  originated from great curvature and not attached to transversal colon. + The stomach and D1-D2 duodenum  layed tranversally.