Ribeiro Edson Augusto, Cruz Ruy Jorge, Moreira Samuel Martins
Hospital Estadual Vila Alpina, São Paulo, Brazil.
Sao Paulo Med J. 2005 May 2;123(3):148-50. doi: 10.1590/s1516-31802005000300012. Epub 2005 Jul 8.
Spigelian hernia is an uncommon spontaneous lateral ventral hernia with an incarceration ratio of around 20%. However, complications such as intestinal obstruction are extremely rare. We report on a case of giant incarcerated Spigelian hernia with a clinical condition of complete intestinal obstruction that was treated using prosthetic polypropylene mesh.
A 72-year-old woman was admitted to the emergency department complaining of diffuse abdominal pain. Abdominal examination revealed a firm 10 x 10 cm tender mass in the lower left quadrant, without surrounding cellulite or tenderness. Plain abdominal radiographs displayed the formation of levels, thus indicating the existence of intestinal obstruction. An abdominal computed tomography scan clearly showed a fluid and air-filled mass in the soft tissue area of the lower left-side abdominal wall. Spigelian incarcerated hernia was diagnosed and the patient underwent emergency surgical repair by means of local incision. The large defect in the abdominal wall was closed up as successive anatomical layers, and a prosthetic polypropylene mesh was set into the lateral aspect of the rectus sheath. The postoperative course was uneventful and the patient was discharged on the seventh postoperative day.
半月线疝是一种罕见的自发性侧腹壁疝，嵌顿率约为20%。然而，肠梗阻等并发症极为罕见。我们报告一例巨大嵌顿性半月线疝合并完全性肠梗阻的病例，采用聚丙烯人工补片进行治疗。
一名72岁女性因弥漫性腹痛入住急诊科。腹部检查发现左下腹有一个坚硬的10×10 cm压痛性肿块，周围无蜂窝织炎或压痛。腹部平片显示有液平面形成，提示存在肠梗阻。腹部计算机断层扫描清楚地显示左下腹壁软组织区域有一个充满液体和气体的肿块。诊断为半月线嵌顿疝，患者通过局部切口接受了急诊手术修复。腹壁的大缺损按连续的解剖层次进行缝合，在腹直肌鞘外侧置入聚丙烯人工补片。术后过程顺利，患者于术后第7天出院。
