Petrushnko Wilson, Isaacs Anna, Hackland Tony, Ghusn Michael
Department of Surgery, Upper Gastrointestinal Department, The Tweed Hospital, Australia.
Department of Anesthesia, John Flynn Hospital, Australia.
Int J Surg Case Rep. 2019;62:14-16. doi: 10.1016/j.ijscr.2019.07.048. Epub 2019 Jul 22.
Obturator hernias account for less than 0.073% of all hernias and less than 1.6% of all cases of mechanical bowel obstructions.
We present a case of a 79 year-old elderly female with two recurrent bowel obstructions that have resolved with conservative management. On the third presentation we performed a totally extraperitoneal repair (TEP) with conscious sedation and a L3/4 spinal block. An obturator defect was patched with a self gripping mesh (progrip). The patient was discharged day 2 post operatively.
Laparoscopic surgery can be safely performed in high risk patients with careful monitoring. Laparoscopic surgery is usually associated with a shorter post-operative length of stay.
This case demonstrates the successful but unconventional repair of an obturator hernia in a patient who had a high risk of significant morbidity and mortality with a more conventional anaesthesia and surgery.
闭孔疝占所有疝气的比例不到0.073%，占所有机械性肠梗阻病例的比例不到1.6%。
我们报告一例79岁老年女性患者，该患者出现两次复发性肠梗阻，均通过保守治疗得以缓解。第三次发病时，我们在清醒镇静和L3/4脊髓阻滞下进行了完全腹膜外修补术（TEP）。用自固定补片（普理灵补片）修补闭孔缺损。患者术后第2天出院。
在仔细监测下，高危患者可安全地进行腹腔镜手术。腹腔镜手术通常术后住院时间较短。
本病例表明，对于采用更传统麻醉和手术方式会有较高严重发病和死亡风险的患者，成功实施了非常规的闭孔疝修补术。
