Choi Pyong Wha
Department of Surgery, Inje University College of Medicine, Ilsan Paik Hospital, 170, Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, Goyang 10380, Republic of Korea.
Int J Surg Case Rep. 2017;31:39-42. doi: 10.1016/j.ijscr.2017.01.006. Epub 2017 Jan 5.
Incisional hernia after appendectomy is rare, affecting 0.4% to 0.9% of cases. The small bowel and omentum are commonly herniated through the abdominal wall defect, but incisional hernia of the sigmoid colon is extremely rare.
A 78-year-old man presented with a right lower quadrant abdominal wall mass on the previous McBurney incision site. He had a history of appendectomy for appendicitis 40 years ago. Computed tomography (CT) showed the sigmoid colon herniated thorough the abdominal wall defect. During the operation, a feces-impacted sigmoid colon was found protruding through the defect of the abdominal wall. Reduction of the sigmoid colon into the peritoneal cavity and herniorrhaphy with primary repair were performed.
The ascending and descending colon are fixed into the retroperitoneum, whereas the transverse and sigmoid colon are not, which can allow these bowel segments to herniate through a weak abdominal wall just as small bowel loops do. However, incisional hernia of the colon is extremely rare. The diagnosis of incisional hernia can be easily made because a reducible abdominal wall mass can be detected by physical examination. In cases with rare type of hernia, CT can identify unusual types of abdominal hernias and differentiate hernias from neoplasms, inflammatory disease, and hematoma.
Although incisional hernia of the colon after appendectomy is extremely rare and preoperative diagnosis by physical examination is difficult, CT is a useful method to make the correct diagnosis, avoiding unnecessary invasive intervention, particularly in patients with an unusual abdominal wall mass.
阑尾切除术后切口疝较为罕见，发生率为0.4%至0.9%。小肠和大网膜常通过腹壁缺损处疝出，但乙状结肠切口疝极为罕见。
一名78岁男性，在之前的麦氏切口部位出现右下腹腹壁肿物。他40年前因阑尾炎行阑尾切除术。计算机断层扫描（CT）显示乙状结肠通过腹壁缺损处疝出。手术中发现一段充满粪便的乙状结肠从腹壁缺损处突出。将乙状结肠还纳至腹腔，并进行疝修补及一期缝合。
升结肠和降结肠固定于腹膜后，而横结肠和乙状结肠则不然，这使得这些肠段可像小肠袢一样通过薄弱的腹壁疝出。然而，结肠切口疝极为罕见。切口疝的诊断可通过体格检查发现可复性腹壁肿物而轻易做出。对于罕见类型的疝，CT可识别不寻常类型的腹外疝，并将疝与肿瘤、炎症性疾病及血肿相鉴别。
尽管阑尾切除术后结肠切口疝极为罕见，且通过体格检查进行术前诊断困难，但CT是做出正确诊断的有用方法，可避免不必要的有创干预，尤其是对于有不寻常腹壁肿物的患者。
