Beznicza Henrietta, Simon Eva, Vizsy László
Nagykanizsa Megyei Jogú Város Kórháza, Altalános Sebészeti Osztály.
Magy Seb. 2004 Oct;57(5):262-6.
The simultaneous occurrence of inguinal hernia and colorectal cancer is rare, but it is well known by surgeons. We call attention to the synchronous diseases with the help of cases accumulating in our department and with the support of literature.
A 76-year-old male hernioplasty by Lichtenstein was performed on, and during the exploration because of ileus having developed in the postoperative period a stenosing rectum carcinoma was discovered. 87-year-old inguinal hernial male patient's sigmoid tumor was justified as a result of complex examination completed before surgery. The resection of sigmoid and simultaneously left-sided hernioplasty were carried out transabdominally with implantation of polypropylene mesh. With a 81-year-old male presenting bilateral inguinal hernia a carcinoma of rectum was found with digital examination. A rectum resection by Dixon was made, and in second stage inguinal herniorrhaphies are planned after cytostatic treatment. With a 94-year-old male patient arriving with incarcerated hernia a stenosing carcinoma of rectum was palpated with rectal digital examination, but the patient refused all intervention. After reposition of abdominal wall hernia of an 81-year-old female patient a tumor was found--through colonoscopic examination--30 cm from anal opening, but the patient rejected any kind of operation.
With the contemporaneous appearance of two diseases should be taken into consideration, when long existing hernia rapidly becomes larger, and complaints emerge with the hernial patients. At this point the complex examination of colon is inevitable during the operative preparation.
腹股沟疝与结直肠癌同时发生的情况较为罕见,但外科医生对此较为熟知。我们借助科室积累的病例并参考文献来关注这种同步出现的疾病。
对一名76岁男性实施了利希滕斯坦疝修补术,在术后因肠梗阻进行探查时发现了一例直肠狭窄癌。一名87岁患有腹股沟疝的男性患者,术前经全面检查确诊为乙状结肠肿瘤。经腹进行了乙状结肠切除并同时实施了左侧疝修补术,植入了聚丙烯补片。一名81岁患有双侧腹股沟疝的男性患者,通过直肠指检发现了直肠癌。进行了迪克森直肠切除术,计划在进行细胞抑制治疗后二期行腹股沟疝修补术。一名94岁因嵌顿疝前来就诊的男性患者,直肠指检可触及直肠狭窄癌,但患者拒绝一切干预措施。一名81岁女性患者腹壁疝复位后,经结肠镜检查在距肛门开口30厘米处发现肿瘤,但患者拒绝任何手术。
当长期存在的疝迅速增大且疝患者出现不适症状时,应考虑两种疾病同时存在的情况。此时,手术准备过程中对结肠进行全面检查是必不可少的。