Department of General and Abdominal Surgery, University Hospital La Paz, Madrid, Spain.
Hernia. 2011 Oct;15(5):571-3. doi: 10.1007/s10029-010-0688-6. Epub 2010 Jun 11.
Acute inguinal hernia complications (incarceration, strangulation) are relatively frequent conditions, especially in the elderly. Urgent surgery is the appropriate treatment if manual reduction is not achieved or strangulation or perforation is suspected. We present a 77-year-old patient with necrotising fasciitis of the lower limb as a consequence of extraperitoneal perforation of a sliding inguinal hernia. This devastating condition was diagnosed 20 h after the manual reduction of the hernia. Suspicion arose at the physical examination (crepitation, signs of cellulitis) and clinical deterioration of the patient, and was confirmed by computed tomography (CT) scanning. Urgent surgery was performed, including sigmoidectomy, debridement of the necrotic tissues of the medial and anterior thigh compartment, and fasciectomy, combined with optimal intensive care support. No signs of peritoneal or pelvic involvement were found. However, the comorbidities, advanced age and the progression of the disease led to fatal outcome. Early recognition of the complications of strangulated hernias is of vital importance for successful treatment in these cases, even if no signs of acute abdomen are present.
腹股沟急性疝并发症（嵌顿、绞窄）较为常见，尤其在老年人中。如果手法复位不成功或怀疑绞窄或穿孔，应紧急手术治疗。我们报告了 1 例 77 岁老年患者，因滑动性腹股沟疝腹膜外穿孔导致下肢坏死性筋膜炎。这种破坏性疾病是在疝手法复位后 20 小时被诊断出来的。体格检查（捻发音、蜂窝织炎迹象）和患者病情恶化引起了怀疑，并通过计算机断层扫描（CT）扫描得到证实。紧急手术包括乙状结肠切除术、大腿内侧和前间隔的坏死组织清创术和筋膜切除术，并结合最佳的重症监护支持。未发现腹膜或骨盆受累的迹象。然而，并存疾病、高龄和疾病的进展导致了致命的结局。即使没有急性腹痛的表现，早期识别绞窄性疝的并发症对这些病例的成功治疗至关重要。
