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一种特殊的肠梗阻病因:闭孔疝嵌顿。

An extraordinary cause of intestinal obstruction, incarcerated obturator hernia.

出版信息

Ann Ital Chir. 2021 May 28;92:S2239253X21034599.

Abstract

AIM

Presenting an extraordinary cause of intestinal obtuction, leading to incarcerated obturator hernia.

CASE REPORT

We present a rare case of obturator hernia in a 90-year-old female, who presented with a three-day history of inability to defecate and abdominal pain, distension, and vomiting on the day of presentation. Hours later, a computed tomography scan revealed a bowel obstruction secondary to a right-sided obturator hernia. She underwent an emergency exploratory laparotomy and the incarcerated bowel was reduced with a repairment of the hernial defect. The patient demonstrated an uneventful postoperative period and was discharged on hospital day four.

DISCUSSION

Obturator hernia, a rare anterior abdominal wall hernia, in which abdominal contents protrude through the obturator canal, is an unusual cause of intestinal obstruction. It has one of the highest mortality rates of all abdominal wall hernias with a challenging diagnosis that can still be misleading even to the most experienced surgeons.

CONCLUSION

Providers should be aware of inability to defecate, abdominal pain, distension, and vomiting that may be due to an existence of incarcerated/strangulated obturator hernia, thus the further evaluation should be considered as the elements of the clinical picture are incongruent.

KEY WORDS

Emergencies, Hernia, Intestines, Intestinal obstruction, Obturator.

摘要

目的

介绍一种导致嵌顿性闭孔疝的肠阻塞的特殊病因。

病例报告

我们报告了一例 90 岁女性闭孔疝的罕见病例,她因排便困难和腹痛、腹胀以及就诊当天呕吐三天而就诊。数小时后,计算机断层扫描显示右侧闭孔疝继发肠阻塞。她接受了紧急剖腹探查术,嵌顿的肠段被复位,疝缺损被修复。患者术后恢复顺利,于住院第四天出院。

讨论

闭孔疝,一种罕见的前腹壁疝,其腹内容物通过闭孔管突出,是一种不常见的肠梗阻病因。它是所有腹壁疝中死亡率最高的疝之一,其诊断极具挑战性,即使是经验最丰富的外科医生也可能出现误诊。

结论

提供者应该意识到无法排便、腹痛、腹胀和呕吐可能是由于嵌顿/绞窄性闭孔疝的存在,因此如果临床症状不相符,应进一步考虑评估。

关键词

急症;疝;肠;肠梗阻;闭孔。

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