Testini Mario, Marzaioli Rinaldo, Gurrado Angela, Lissidini Germana, Piccinni Giuseppe
Section of General and Thoracic Surgery, Department of Applications in Surgery of Innovative Technologies, University of Bari, Bari, Italy.
Int Surg. 2007 Sep-Oct;92(5):296-9.
Hernia repair is the most commonly practiced operation in the departments of surgery in developed countries. Huge abdominal hernias are uncommon in western civilization. We present a rare case of a 73-year-old woman with a diagnosis at admission of intestinal obstruction caused by a giant strangulated umbilical hernia. At the clinical and radiological examination, the patient showed an enormous strangulated umbilical hernia with acute abdomen, atrial fibrillation, and pulmonary subedema. Emergency laparotomy showed a huge peritoneal umbilical sac containing massive mesenteric ischemia starting from 40 cm after the Treitz ligament and extended to the right colonic flexure. A near-total resection of the small bowel, a right colectomy with double terminal stomas, and a direct hernia repair without prosthetic mesh were performed. Twenty days after the operation, the patient was discharged and begun domiciliary total parenteral nutrition, and 24 months after surgical treatment she is still alive.
疝修补术是发达国家外科科室最常开展的手术。巨大腹壁疝在西方文明社会并不常见。我们报告一例罕见病例，一名73岁女性，入院诊断为巨大绞窄性脐疝导致的肠梗阻。临床和影像学检查显示，患者有巨大绞窄性脐疝，伴有急腹症、心房颤动和肺水肿。急诊剖腹探查发现一个巨大的腹膜脐疝囊，伴有从屈氏韧带后40厘米处开始并延伸至右结肠曲的大量肠系膜缺血。进行了小肠近全切除术、带双末端造口的右半结肠切除术以及无人工补片的直接疝修补术。术后20天，患者出院并开始家庭全胃肠外营养，手术治疗24个月后她仍然存活。
