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肝移植术后含阑尾的半月线疝首例病例报告：慢性腹痛的另一病因

First case report of spigelian hernia containing the appendix after liver transplantation: Another cause for chronic abdominal pain.

作者信息

Sobrado Lucas Faraco, Ernani Lucas, Waisberg Daniel Reis, Carneiro-D'Albuquerque Luiz Augusto, Andraus Wellington

机构信息

Digestive Organs Transplant Unit, Department of Gastroenterology, Liver Transplantation Division, University of São Paulo School of Medicine, São Paulo, Brazil.

Digestive Organs Transplant Unit, Department of Gastroenterology, Liver Transplantation Division, University of São Paulo School of Medicine, São Paulo, Brazil.

出版信息

Int J Surg Case Rep. 2020;72:533-536. doi: 10.1016/j.ijscr.2020.06.003. Epub 2020 Jun 16.

DOI:10.1016/j.ijscr.2020.06.003
PMID:32698282
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7322101/
Abstract

INTRODUCTION

Abdominal ventral hernias are common in chronic liver disease due to increased abdominal pressure and sarcopenia. Following liver transplantation, diagnosis of chronic abdominal pain is challenging because it may relate to immunosuppression, scaring or opportunistic infections.

PRESENTATION OF CASE

A 62 years-old male presented with chronic abdominal pain one year following liver transplantation due to hepatocellular carcinoma. After work-up he was diagnosed with a Spigelian hernia containing the appendix. We did hernia repair with mesh but appendectomy was not performed since it showed no signs of inflammation. On follow-up the patient had complete resolution of the pain.

DISCUSSION

This is the first case of spigelian hernia containing the appendix following liver transplantation. Mesh repair can be safely performed in this setting but incidental appendectomy is controversial due to higher morbidity and mortality. In this case report we discuss the relationship between liver transplantation, abdominal hernias and the pitfalls of incidental appendectomy.

CONCLUSION

Uncommon ventral hernias are a possible cause for chronic abdominal pain after surgery and should be investigated with imaging studies. Mesh repair is safe but incidental appendectomy in the immunosuppressed is not encouraged due to increased morbidity.

摘要

引言

由于腹压增加和肌肉减少症，腹部腹侧疝在慢性肝病中很常见。肝移植后，慢性腹痛的诊断具有挑战性，因为它可能与免疫抑制、瘢痕形成或机会性感染有关。

病例介绍

一名62岁男性在因肝细胞癌进行肝移植一年后出现慢性腹痛。经过检查，他被诊断为含有阑尾的半月线疝。我们用补片进行了疝修补，但由于阑尾没有炎症迹象，未进行阑尾切除术。随访时患者疼痛完全缓解。

讨论

这是肝移植后首例含有阑尾的半月线疝病例。在这种情况下可以安全地进行补片修补，但由于较高的发病率和死亡率，偶然阑尾切除术存在争议。在本病例报告中，我们讨论了肝移植、腹部疝和偶然阑尾切除术的陷阱之间的关系。

结论

罕见的腹侧疝是术后慢性腹痛的一个可能原因，应通过影像学检查进行评估。补片修补是安全的，但由于发病率增加，不鼓励在免疫抑制患者中进行偶然阑尾切除术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/621f/7322101/a5e42b1085b0/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/621f/7322101/605c55ed00a9/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/621f/7322101/e5cfc45e9a23/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/621f/7322101/311ded793075/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/621f/7322101/a5e42b1085b0/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/621f/7322101/605c55ed00a9/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/621f/7322101/e5cfc45e9a23/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/621f/7322101/311ded793075/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/621f/7322101/a5e42b1085b0/gr4.jpg

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Case of Spigelian hernia with incarcerated appendix.伴有阑尾嵌顿的半月线疝病例。
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An unusual presentation of an incarcerated Spigelian hernia.一例闭孔疝的罕见表现。 （注：原文中“Spigelian hernia”有误，正确的是“Spigelian疝”，但按照要求翻译，这里保留了原文错误表述。准确译文应该是“一例闭孔疝的罕见表现” ，闭孔疝英文是“ obturator hernia” ，而Spigelian疝是半月线疝 ）
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Mortality Related to Appendectomy; a Population Based Analysis over Two Decades in Finland.与阑尾切除术相关的死亡率；芬兰二十年的基于人群的分析。
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Abdominal wall hernia in cirrhotic patients: emergency surgery results in higher morbidity and mortality.肝硬化患者的腹壁疝：急诊手术会导致更高的发病率和死亡率。
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Twelve years of experience treating Spigelian hernia.治疗半月线疝的十二年经验。
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