Yamazaki Yuta, Otowa Yasunori, Kusano Shunsuke, Nakajima Koichi, Satake Shinsuke, Yamasaki Yoshisada
Department of Surgery, Shiso Municipal Hospital, Shiso, Japan.
Asian J Endosc Surg. 2018 Aug;11(3):277-279. doi: 10.1111/ases.12453. Epub 2018 Jan 8.
Obturator hernia (OH) is a rare cause of bowel obstruction. Although several surgical approaches, including the laparoscopic approach, have been reported to date, a standard approach for treating OH has not been established. A 101-year-old woman who presented with constipation and vomiting was admitted to our hospital. CT revealed an incarcerated small bowel within the left obturator foramen, and a diagnosis of left-sided incarcerated OH with small bowel ileus was made. With the patient under general anesthesia, exploratory laparoscopy was performed; we identified an OH with an incarcerated small bowel, which was judged viable after hernia reduction. We repaired the hernia using an anterior preperitoneal approach under laparoscopic assistance and placed a prosthetic mesh over the obturator foramen. The patient recovered with no postoperative complications and was discharged on postoperative day 4. A hybrid laparoscopic and anterior preperitoneal approach is safe and effective for treating an incarcerated OH in an elderly patient.
闭孔疝（OH）是肠梗阻的一种罕见病因。尽管迄今为止已报道了多种手术方法，包括腹腔镜手术，但尚未确立治疗OH的标准方法。一名因便秘和呕吐入院的101岁女性。CT显示左闭孔内有一段嵌顿的小肠，诊断为左侧嵌顿性OH伴小肠梗阻。在全身麻醉下对患者进行了腹腔镜探查；我们发现了一个伴有嵌顿小肠的OH，在疝还纳后判断小肠存活。我们在腹腔镜辅助下采用前入路腹膜前修补法修复疝，并在闭孔上放置了人工补片。患者术后无并发症恢复良好，术后第4天出院。腹腔镜与前入路腹膜前联合手术方法治疗老年患者嵌顿性OH安全有效。
