Bailon-Cuadrado M, Rodriguez-Lopez M, Blanco-Alvarez J I, Rodriguez-Vielba P L
Rio Hortega University Hospital , Valladolid , Spain.
Ann R Coll Surg Engl. 2016 May;98(5):e82-3. doi: 10.1308/rcsann.2016.0133.
Prevalence of Littre's hernia (protrusion of a Meckel´s diverticulum through an opening in the abdominal wall) is very low, and Littre's hernias found in an umbilical site are uncommon. Even rarer are cases of an incarcerated hernia resulting in a surgical emergency. Trocar-site hernias are a relatively common complication after laparoscopic cholecystectomy that develop in association with insertion of wide trocars (usually at the umbilical port).
A 63-year-old female with a history of obesity, diabetes mellitus, hypertension, laparoscopic cholecystectomy and open hysterectomy arrived at hospital complaining of acute umbilical pain but with no other symptoms or fever. A painful mass observed was believed to be an incarcerated umbilical hernia at a trocar site used in previous laparoscopic surgery. Emergency surgery was undertaken: the opening of the hernia sac revealed a Meckel's diverticulum within it. The Meckel's diverticulum was resected using a stapler, followed by herniorrhaphy and hernioplasty. Postoperative recovery was uneventful.
An incarcerated umbilical Littre's hernia at a laparoscopic trocar site has not been reported before. To avoid this complication, we agree with the numerous authors who recommend closure of trocar sites of width ≥10mm.
里脱疝（梅克尔憩室经腹壁开口突出）的患病率极低，而在脐部发现的里脱疝并不常见。更罕见的是嵌顿疝导致外科急症的情况。套管针穿刺部位疝是腹腔镜胆囊切除术后相对常见的并发症，与较宽套管针（通常在脐部端口）的插入有关。
一名63岁女性，有肥胖、糖尿病、高血压、腹腔镜胆囊切除术和开腹子宫切除术史，因急性脐部疼痛入院，但无其他症状或发热。观察到的疼痛性肿块被认为是先前腹腔镜手术使用的套管针部位的嵌顿性脐疝。进行了急诊手术：打开疝囊后发现其中有一个梅克尔憩室。使用吻合器切除梅克尔憩室，随后进行疝修补术和疝成形术。术后恢复顺利。
此前尚未报道过腹腔镜套管针部位的嵌顿性脐部里脱疝。为避免这种并发症，我们赞同众多作者的建议，即闭合宽度≥10mm的套管针穿刺部位。
