Ramkumar Jonathan, Lu Daphne, Scott Tracy
University of British Columbia, Division of General Surgery, Vancouver, BC, Canada
University of British Columbia, Division of General Surgery, Vancouver, BC, Canada.
Perit Dial Int. 2019 Jan-Feb;39(1):95-97. doi: 10.3747/pdi.2018.00203.
Abdominal wall hernias are prevalent in patients undergoing peritoneal dialysis (PD). Obturator hernias, first described by Arnaud de Ronsil in 1724, are an uncommon type of hernia where intra-abdominal contents protrude through the obturator foramen. The following case highlights a rare presentation of bilateral obturator hernias with right femoral and inguinal hernia in an 82-year-old woman post-PD. This patient presented with 5 months of bilateral thigh pain and swelling and was found to only have a right-sided obturator hernia on computer tomography (CT) scan. Intraoperatively, bilateral obturator hernias were found along with right inguinal and femoral hernias, which were all repaired laparoscopically with polypropylene mesh. Postoperatively, the patient developed a self-limiting port site hematoma and resumed PD 1 month post-surgery. Due to the high morbidity and mortality from obturator hernias, prompt diagnosis and treatment are imperative. Compared with open hernia repair, laparoscopic hernia repairs are associated with quicker return to usual activities and less persisting pain and numbness. This case portrays that laparoscopic approach to bilateral obturator hernias can be considered in patients post-PD.
腹壁疝在接受腹膜透析（PD）的患者中很常见。闭孔疝于1724年由阿诺德·德·龙西尔首次描述，是一种罕见的疝类型，腹腔内容物通过闭孔突出。以下病例突出显示了一名82岁PD术后女性罕见的双侧闭孔疝合并右侧股疝和腹股沟疝的表现。该患者出现双侧大腿疼痛和肿胀5个月，计算机断层扫描（CT）仅发现右侧闭孔疝。术中发现双侧闭孔疝以及右侧腹股沟疝和股疝，均用聚丙烯网片进行腹腔镜修补。术后，患者出现自限性穿刺部位血肿，术后1个月恢复腹膜透析。由于闭孔疝的高发病率和死亡率，必须及时诊断和治疗。与开放疝修补术相比，腹腔镜疝修补术可使患者更快恢复日常活动，且持续疼痛和麻木较少。该病例表明，PD术后患者可考虑采用腹腔镜方法治疗双侧闭孔疝。
