Katoh Takeaki, Kawamoto Ryuichi, Kusunoki Tomo
Department of Internal Medicine, Seiyo Municipal Nomura Hospital.
Nihon Ronen Igakkai Zasshi. 2011;48(2):176-9. doi: 10.3143/geriatrics.48.176.
We report a case of a patient with incarcerated obturator hernia who presented with right thigh pain. An 88-year-old woman who had experienced right thigh pain for the previous 3 years was given a diagnosis of sciatica at the orthopedic department. In July 2009, she was hospitalized with the chief complaint of appetite loss. The day after admission she experienced increased right thigh pain and lower abdominal pain. Abdominal ultrasonography revealed a keyboard sign. Based on this finding, we diagnosed an ileus, which was alleviated by the insertion of an ileus tube. However, after the removal of the ileus tube, her right thigh pain recurred. Therefore, a diagnosis of hernia was considered. Contrast-enhanced computed tomography revealed an incarcerated bowel in the region between the pectineus muscle and muscle obturator. Laparotomy showed that the ileal part located about 15 cm from the terminal ileum was incarcerated in the right foramen obturatum; therefore, ileal resection and end-to-end anastomosis were performed. After the operation, her intestinal obstruction symptoms and right pain disappeared. If right pain and ileus symptoms of unknown cause occur in elderly persons, obturator hernia should be considered.
我们报告一例闭孔疝嵌顿患者，其表现为右大腿疼痛。一名88岁女性，既往3年一直有右大腿疼痛，在骨科被诊断为坐骨神经痛。2009年7月，她因食欲减退为主诉入院。入院次日，她出现右大腿疼痛加剧及下腹部疼痛。腹部超声显示键盘征。基于此发现，我们诊断为肠梗阻，通过插入肠梗阻导管使其缓解。然而，在拔除肠梗阻导管后，她的右大腿疼痛复发。因此，考虑诊断为疝。增强计算机断层扫描显示耻骨肌和闭孔肌之间区域有一段肠管嵌顿。剖腹探查显示距回肠末端约15 cm处的回肠部分嵌顿于右侧闭孔；因此，进行了回肠切除及端端吻合术。术后，她的肠梗阻症状和右大腿疼痛消失。如果老年人出现原因不明的右大腿疼痛和肠梗阻症状，应考虑闭孔疝。
