Dong Yuan-Qiang, Liu Li-Jia, Fu Zan, Chen Si-Meng
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
World J Clin Cases. 2020 Jan 26;8(2):362-369. doi: 10.12998/wjcc.v8.i2.362.
Sacrococcygeal hernia is a very rare condition that is usually secondary to sacrococcygectomy, and its ideal treatment regimen is unclear. Herein, we report a case of sacrococcygeal hernia occurring in a patient who had no history of sacrococcygeal operation, present the operative procedures of mesh repair a combined laparoscopic and sacrococcygeal approach that has not been described, and discuss our experience in diagnosis and treatment with a review of the literature.
A 54-year-old woman who chiefly complained of a 10-year history of a reversible bulge in her right sacrococcygeal region was admitted to our hospital. The physical examination revealed a bulge in the right sacrococcygeal region upon standing, which disappeared in the prone position but relapsed when performing the Valsalva manoeuvre. Computed tomography displayed an abnormality in the structure of the tissues between the midline of the sacrococcygeal region and the right gluteus muscle. The patient was diagnosed with sacrococcygeal hernia and received hernia repair with mesh through a combined laparoscopic and sacrococcygeal approach. On laparoscopy, the rectum was dissected posterolaterally, and a defect was identified in the right anterior sacrococcygeal region through which part of the rectum protruded. This was followed by the placement of a self-gripping polyester mesh a sacrococcygeal approach. There were no postoperative complications. The patient was discharged on postoperative day 7 and was followed for more than 6 mo with no recurrence.
Laparoscopic mesh repair is recommended as a priority of surgical options for sacrococcygeal hernias, while choosing a self-gripping mesh can help avoid the risk of presacral vessel injury by reducing suture fixation.
骶尾部疝是一种非常罕见的疾病，通常继发于骶尾骨切除术，其理想的治疗方案尚不清楚。在此，我们报告一例无骶尾骨手术史的患者发生骶尾部疝的病例，介绍一种尚未描述的腹腔镜与骶尾骨联合入路的补片修补手术方法，并结合文献复习讨论我们的诊治经验。
一名54岁女性因主诉右骶尾骨区域可复性肿物10年入院。体格检查发现站立时右骶尾骨区域有肿物，俯卧位时消失，行瓦尔萨尔瓦动作时复发。计算机断层扫描显示骶尾骨区域中线与右臀肌之间的组织结构异常。该患者被诊断为骶尾部疝，并通过腹腔镜与骶尾骨联合入路接受补片修补术。在腹腔镜检查中，直肠从后外侧进行解剖，在右前骶尾骨区域发现一个缺损，部分直肠由此突出。随后通过骶尾骨入路放置自固定聚酯补片。术后无并发症。患者术后第7天出院，随访6个月以上无复发。
腹腔镜补片修补术推荐作为骶尾部疝手术选择的首选，选择自固定补片可通过减少缝合固定来避免骶前血管损伤的风险。
