Ng Chu Woon, Sandstrom Anna, Lim Grace
Department of Surgery, Bundaberg Base Hospital, Bundaberg, QLD, Australia.
J Med Case Rep. 2018 Apr 15;12(1):96. doi: 10.1186/s13256-018-1645-8.
Hernias of the posterior rectus sheath are very rare abdominal wall hernias with only a handful of cases reported in the literature to date. As an uncommon disease, it is important to recognize and report this case in order to enhance scientific knowledge of this disease.
This case report presents a spontaneous posterior rectus sheath herniation in a 79-year-old white man with previous abdominal surgery for appendicitis. His herniation was discovered incidentally during an examination for his chief complaints of lower abdominal pain and diarrhea which were later diagnosed as Salmonella-related gastroenteritis. A computed tomography scan of his abdomen and pelvis showed abdominal wall hernia with loops of small bowel extending into his rectus abdominis muscle. In this case, it was decided to leave the situation alone for now due to no evidence of bowel obstruction and the low risk of this hernia getting strangulated, which otherwise would have warranted urgent surgery.
This report adds to the limited stock of available literature on this unusual issue and strengthens the evidence base on the best approach to support informed clinical decision making. The significant clinical implication of such case reports is increased identification rate of rare clinical conditions which otherwise often go unnoticed.
腹直肌后鞘疝是非常罕见的腹壁疝，迄今为止文献中仅报道了少数病例。作为一种罕见疾病，认识并报告该病例对于增进对这种疾病的科学认识很重要。
本病例报告呈现了一名79岁白人男性的自发性腹直肌后鞘疝，该患者既往因阑尾炎接受过腹部手术。他的疝是在因下腹痛和腹泻等主要症状进行检查时偶然发现的，后来这些症状被诊断为沙门氏菌相关性肠胃炎。他腹部和骨盆的计算机断层扫描显示腹壁疝，小肠袢延伸至腹直肌。在这种情况下，由于没有肠梗阻的证据且该疝发生绞窄的风险较低，决定目前暂不处理，否则将需要紧急手术。
本报告增加了关于这个不寻常问题的有限文献储备，并加强了支持明智临床决策的最佳方法的证据基础。此类病例报告的重要临床意义在于提高了罕见临床病症的识别率，否则这些病症常常会被忽视。
