Panaccio Paolo, Raimondi Paolo, Fiordaliso Michele, Dell'Osa Antonio, Cotellese Roberto, Innocenti Paolo
Ann Ital Chir. 2016 Jul 15;87:S2239253X16025718.
Describe a rare case of intestinal obstruction due to sigmoid colon incarceration into a right Spigelian hernia and provide a literature review about its surgical management.
An 88 year-old man presented with a 3-day history of right lower quadrant pain and abdominal distension. Clinical examination revealed a not reducible palpable mass on right side of the anterior abdominal wall. Computed tomography shown signs of intestinal obstruction and a Spigelian hernia of about 3 cm.
Sigmoid colon was incarcerated in the defect but no signs of intestinal ischemia was found during the surgical exploration. The hernia content was reduced and the defect was repaired with a polypropylene mesh placed in the pre-peritoneal space. Postoperative period was uneventful and the patient was discharged on the fourth postoperative day.
Spigelian hernia occurs through congenital or acquired defects in the Spigelian fascia at the level of the semicircular line. Clinical presentation depends on the size and the pattern of the hernia defect. In some cases, symptoms are no specific and uncommon findings have been reported so far. Preoperative establishment of the hernia content and the location of the sac is mandatory to plan a correct surgical strategy. Intestinal incarceration often occurs and suggests a prompt surgical exploration.
Colonic obstruction secondary to an incarcerated Spigelian hernia is a rare but dangerous occurrence. Surgical approach is selected based on patient's conditions and surgeon's expertise. In a non-contaminated surgical field, the use of prosthesis is recommended.
Intestinal obstruction, Mesh repair, Spigelian hernia.
描述一例罕见的因乙状结肠嵌顿于右侧半月线疝导致肠梗阻的病例，并对其手术治疗进行文献综述。
一名88岁男性，有3天右下腹疼痛和腹胀病史。临床检查发现前腹壁右侧有一个不可回纳的可触及肿块。计算机断层扫描显示肠梗阻征象及一个约3厘米的半月线疝。
手术探查发现乙状结肠嵌顿于缺损处，但未发现肠缺血迹象。将疝内容物回纳，在腹膜前间隙放置聚丙烯网片修补缺损。术后恢复顺利，患者于术后第4天出院。
半月线疝通过半月线水平的半月线筋膜先天性或后天性缺损形成。临床表现取决于疝缺损的大小和类型。在某些情况下，症状不具特异性，目前已报道的罕见表现较多。术前明确疝内容物及疝囊位置对于制定正确的手术策略至关重要。肠嵌顿常发生，提示需及时进行手术探查。
嵌顿性半月线疝继发结肠梗阻是一种罕见但危险的情况。根据患者情况和外科医生的专业技能选择手术方式。在未污染的手术区域，建议使用假体。
肠梗阻；网片修补；半月线疝
