Lee Seung Eun
Department of Surgery, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul 156-755, Republic of Korea.
Int J Surg Case Rep. 2012;3(11):563-4. doi: 10.1016/j.ijscr.2012.08.002. Epub 2012 Aug 14.
Giant inguinal hernia is uncommon nowadays.
A 75-year-old man with schizophrenia presented with complaints of episodic abdomen pain and constipation accompanied by a huge right scrotal mass. Physical examination revealed a large, irreducible, non-tender right inguinoscrotal hernia. The hernial mass was about 30cm and extended to the midpoint of the inner thigh. At laparotomy, the intestine from the proximal transverse colon to the terminal ileum with mesentery was found to have herniated through the right inguinal tract without evidence of ischemia or strangulation. The ascending colon showed no adherence to the retroperitoneum and the third and fourth parts of the duodenum descended vertically without Treitz's ligament. The inguinal defect was closed without complications. Ladd's procedure and appendectomy were performed simultaneously.
Several techniques such as distending the abdominal wall progressively or debulking the abdominal contents have been reported. However, no consensus has been reached on a standard surgical procedure for the management of giant inguinoscrotal hernias.
This was the first reported case of giant inguinal hernia containing malrotated intestine.
巨大腹股沟疝如今并不常见。
一名75岁的精神分裂症男性患者，主诉阵发性腹痛和便秘，并伴有右侧阴囊巨大肿块。体格检查发现右侧腹股沟阴囊有一个巨大、不可回纳、无压痛的疝。疝块约30厘米，延伸至大腿内侧中点。剖腹手术时，发现从近端横结肠至回肠末端带系膜的肠管经右侧腹股沟管疝出，无缺血或绞窄迹象。升结肠未与腹膜后粘连，十二指肠第三和第四部分垂直下降，无Treitz韧带。腹股沟缺损得以闭合，未出现并发症。同时进行了Ladd手术和阑尾切除术。
已报道了多种技术，如逐步扩张腹壁或减少腹腔内容物体积。然而，对于巨大腹股沟阴囊疝的标准手术治疗方法尚未达成共识。
这是首例报道的包含肠旋转不良的巨大腹股沟疝病例。
