Uchenna Eleje George, Chukwuneme Okpala Boniface, Ejike Enendu Stephen, Mbanefo Okeke Paul, Benjamin Ejikeme Toochukwu
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria.
Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria.
Niger Med J. 2014 May;55(3):271-3. doi: 10.4103/0300-1652.132069.
The management of a large incisional hernia amidst gravid uterus in its sac is a very challenging obstetric entity. Because of the uncommonness of this entity, there has not been any evidence-based guideline regarding the optimal mode of treatment and so treatment is largely individualised. We present the case of a 32-year-old booked G7P6+0 Nigerian woman with two living children who was already booked for elective repeat lower segment Caesarean section (CS) and 'Caesarean' herniorrhaphy at 38 weeks of gestation but only to present at 36-weeks gestation with a 4-hour history of labour pains. She had an emergency lower segment CS 2 years earlier due to obstructed labour but the CS was complicated by wound infection. Examination revealed gravid uterus that herniated through the incisional hernia. She subsequently had emergency lower segment CS with the repair of the hernia with polypropylene mesh. She had uneventful post-operative recovery. Herniated uterus of near-term pregnancy through an incisional hernia has not been reported in our hospital. As in our case, triumphant management required brave but multidisciplinary approach and currently there are emerging management options such as the use of mesh and laparoscopic technique.
妊娠子宫疝入切口疝囊内的巨大切口疝的处理是一个极具挑战性的产科情况。由于这种情况罕见，尚无关于最佳治疗方式的循证指南，因此治疗很大程度上是个体化的。我们报告一例32岁、孕7产6+0的尼日利亚女性病例，她育有两个存活子女，已预约在妊娠38周时择期行再次下段剖宫产术及“剖宫产”切口疝修补术，但在妊娠36周时出现了4小时的宫缩痛。她两年前因产程梗阻行急诊下段剖宫产术，但术后出现伤口感染。检查发现妊娠子宫经切口疝突出。随后她接受了急诊下段剖宫产术，并使用聚丙烯网片修补疝。术后恢复顺利。我院尚未报道过近足月妊娠子宫经切口疝突出的病例。正如我们的病例所示，成功的处理需要勇敢且多学科的方法，目前出现了一些新的处理选择，如使用网片和腹腔镜技术。
