Tokushima Midori, Aihara Hidetoshi, Tago Masaki, Tomonaga Motosuke, Sakanishi Yuta, Yoshioka Tsuneaki, Hyakutake Masaki, Kyoraku Itaru, Sugioka Takashi, Yamashita Shu-Ichi
Department of General Medicine, Saga University Hospital, Saga City, Japan ; The Community Center of General Medicine, Saga University Hospital, Saga City, Japan.
Department of General Medicine, Saga University Hospital, Saga City, Japan.
Am J Case Rep. 2014 Jun 28;15:280-3. doi: 10.12659/AJCR.890555. eCollection 2014.
Female, 90 FINAL DIAGNOSIS: Obturator hernia Symptoms: Epigastric pain • vomiting
Challenging differential diagnosis.
Obturator hernia (OH) can be difficult to diagnose because it shows only nonspecific signs and symptoms. Although pain in a lower limb caused by compression of the obturator nerve by the hernia in the obturator canal (Howship-Romberg sign) is a characteristic sign, its presence is rather rare.
We herein describe the case of a 90-year-old woman with an OH that was difficult to diagnose because of her slight abdominal signs and symptoms on admission and subtle abdominal computed tomography (CT) findings. Although the CT images revealed the presence of an OH, this finding was overlooked because it contained only a part of the small intestine wall, which is called the Richter type. Fortunately, her condition improved dramatically with only conservative treatment.
Although early diagnosis is essential to reduce morbidity and mortality, OH can be a diagnostic challenge even with abdominal CT.
女性，90岁 最终诊断：闭孔疝 症状：上腹部疼痛、呕吐
具有挑战性的鉴别诊断
闭孔疝（OH）可能难以诊断，因为其仅表现出非特异性体征和症状。尽管疝在闭孔管内压迫闭孔神经导致下肢疼痛（豪希普-龙贝格征）是其特征性体征，但这种情况相当罕见。
我们在此描述一名90岁女性闭孔疝病例，因其入院时腹部体征和症状轻微以及腹部计算机断层扫描（CT）表现不明显而难以诊断。尽管CT图像显示存在闭孔疝，但这一发现被忽视了，因为疝内仅包含小肠壁的一部分，即里氏型。幸运的是，仅通过保守治疗她的病情就显著改善。
尽管早期诊断对于降低发病率和死亡率至关重要，但即使使用腹部CT，闭孔疝仍可能是一个诊断难题。
