Ueda Junji, Yoshida Hiroshi, Makino Hiroshi, Maruyama Hiroshi, Yokoyama Tadashi, Hirakata Atsushi, Akagi Ichiro, Watanabe Manabu, Uchida Eiichi, Uchida Eiji
Department of Surgery, Nippon Medical School Tama Nagayama Hospital.
J Nippon Med Sch. 2016;83(2):93-6. doi: 10.1272/jnms.83.93.
The uterus, ovary, and fallopian tube are rarely present in an inguinal hernia. We report on an operation to treat just such a rare condition for a right inguinal hernia. An 87-year-old Japanese woman was admitted with swelling in the right inguinal region and a purulent discharge from the vagina. Vital signs were stable, but the mobile mass was irreducible. Computed tomography of the abdomen indicated uterine tissue in a right inguinal hernia. We diagnosed an inguinal hernia with an incarcerated uterus and performed surgery on that basis. An incision approximately 6 cm long was made in the skin above the swollen area to open the inguinal sac, disclosing a tumor enveloped by a hernial sac. Opening the hernial sac revealed the prolapsed uterus, the fallopian tube, and the right ovary. Because no ischemic change was noted, the incarcerated uterus was returned to the abdominal cavity, and the hernial opening was closed with the onlay mesh technique. The posterior wall of the inguinal canal was found to have prolapsed laterally to the inferior epigastric artery, resulting in an external inguinal hernia. This case demonstrates that careful attention must be paid to inguinal hernias in female patients because the uterus, ovary, and fallopian tube may be involved.
子宫、卵巢和输卵管很少出现在腹股沟疝中。我们报告了一例针对右侧腹股沟疝这种罕见情况的手术治疗。一名87岁的日本女性因右侧腹股沟区肿胀和阴道脓性分泌物入院。生命体征稳定，但可移动肿块无法回纳。腹部计算机断层扫描显示右侧腹股沟疝中有子宫组织。我们诊断为嵌顿性子宫腹股沟疝，并在此基础上进行了手术。在肿胀区域上方的皮肤上做了一个约6厘米长的切口，打开腹股沟疝囊，发现一个被疝囊包裹的肿物。打开疝囊后发现脱垂的子宫、输卵管和右侧卵巢。由于未发现缺血性改变，将嵌顿的子宫回纳至腹腔，并用补片修补技术关闭疝口。发现腹股沟管后壁向腹壁下动脉外侧脱垂，导致腹股沟外疝。该病例表明，对于女性患者的腹股沟疝必须予以仔细关注，因为可能涉及子宫、卵巢和输卵管。
