Lau Hung
Department of Surgery, University of Hong Kong Medical Center, Tung Wah Hospital, China.
JSLS. 2003 Apr-Jun;7(2):173-5.
Painful preperitoneal collection is a rare complication following endoscopic totally extraperitoneal inguinal hemioplasty. Here we present the case of a woman who underwent endoscopic extraperitoneal inguinal hernioplasty for a left inguinal hernia. Her past health was good. During the dissection of the extraperitoneal space, clear ascitic fluid was noted upon breaching the peritoneum near the round ligament. Endoscopic stapling was used to close the peritoneal tear, and the procedure was completed uneventfully. The patient complained of left iliac pain after the operation. A physical examination showed no swelling over the left iliac fossa. Contrast computed tomography of the abdomen revealed preperitoneal fluid collection over the hernioplasty site and a small amount of ascites. Expectant treatment with pain control by oral analgesics was adopted. A follow-up CT scan 4 months after the operation showed resolution of the preperitoneal fluid collection but with increased ascites. Abdominal paracentesis with peritoneal fluid for cytology analysis found adenocarcinoma cells. The patient succumbed to a terminal malignancy a year after surgery. Conversion of endoscopic extraperitoneal inguinal hernioplasty to open repair should be considered upon intraoperative discovery of ascites. Painful preperitoneal collection is a possible sequela following endoscopic extraperitoneal hernioplasty in patients with malignant ascites.
疼痛性腹膜前积液是内镜下完全腹膜外腹股沟疝修补术后一种罕见的并发症。在此，我们报告一例接受内镜下腹膜外腹股沟疝修补术治疗左侧腹股沟疝的女性病例。她既往健康状况良好。在腹膜外间隙分离过程中，在靠近圆韧带处突破腹膜时发现清亮腹水。采用内镜下吻合器闭合腹膜撕裂口，手术顺利完成。术后患者诉左髂部疼痛。体格检查显示左髂窝无肿胀。腹部增强CT显示疝修补部位腹膜前积液及少量腹水。采取口服镇痛药控制疼痛的保守治疗。术后4个月的随访CT扫描显示腹膜前积液消失，但腹水增多。经腹穿刺抽取腹水进行细胞学分析发现腺癌细胞。患者术后一年死于终末期恶性肿瘤。术中发现腹水时应考虑将内镜下腹膜外腹股沟疝修补术转为开放修补。对于合并恶性腹水的患者，疼痛性腹膜前积液是内镜下腹膜外疝修补术后可能出现的后遗症。
