General Surgery, Wexford General Hospital, Wexford, Ireland
General Surgery, Wexford General Hospital, Wexford, Ireland.
BMJ Case Rep. 2020 Dec 28;13(12):e238252. doi: 10.1136/bcr-2020-238252.
An 85-year-old malnourished woman presented with symptoms of small bowel obstruction of uncertain aetiology. She had presented numerous times over the previous 2 years with symptoms of left groin and thigh pain, vomiting and abdominal distension. A CT of her abdomen and pelvis ultimately revealed a left-sided pelvic hernia, between the obturator internus and pectineal muscles. This was consistent with an obturator hernia. Diagnostic laparoscopy confirmed an obturator hernia of Richter type, incarcerated within the left obturator canal. Reduction revealed a hernia sac containing viable small bowel. A primary repair was performed using a double-layer suture technique to both close and plug the hernia defect. The patient rapidly recovered following hernia repair, with resolution of all previous long-standing symptoms. This case exemplifies the typical presentation of an obturator hernia and the diagnostic challenge it poses to clinicians.
一位 85 岁营养不良的女性出现了不明病因的小肠梗阻症状。在过去的 2 年中，她曾多次出现左腹股沟和大腿疼痛、呕吐和腹胀的症状。腹部和骨盆的 CT 最终显示左侧骨盆疝，位于闭孔内肌和耻骨肌之间。这与闭孔疝一致。诊断性腹腔镜检查证实为 Richter 型闭孔疝，嵌顿于左侧闭孔管内。复位后发现疝囊中含有有活力的小肠。使用双层缝合技术进行了一期修补，以闭合和堵塞疝缺损。患者在疝修补术后迅速恢复，所有以前长期存在的症状均得到缓解。本例典型地表现出闭孔疝的表现，并对临床医生提出了诊断挑战。
