Budiono Bernardus Parish, Chionardes Melissa Angela, Prasetyo Sigit Adi, Riwanto Ignatius
Surgery Department, Faculty of Medicine, Diponegoro University, Semarang, Indonesia.
Faculty of Medicine, Diponegoro University, Semarang, Indonesia.
Ann Med Surg (Lond). 2022 Jan 26;74:103311. doi: 10.1016/j.amsu.2022.103311. eCollection 2022 Feb.
Umbilical hernia usually manifests as a bulging of umbilicus. Invisible incarcerated umbilical hernia has never been reported.
A 53-years-old obese woman admitted to hospital with abdominal pain and vomitus one day after discharged from other hospital, was managed conservatively as an adhesion small bowel obstruction (ASBO) for seven days. There was history of caesarean section 20 years ago. Abdomen was bloated, there was transverse scar wound in hypogastric region and no signs of external abdominal hernia. Plain abdominal x-ray showed dilated small bowel located in the central part of the abdomen. Abdominal CT scan was done to determine the other cause besides adhesion, it showed incarcerated umbilical hernia and gallbladder stone. Herniorrhaphy and laparoscopic cholecystectomy were performed. During surgery, there was a loop of vital small bowel, trapped in the umbilical defect. Mayo method was performed to close the defect.
The other causes of small bowel obstruction should be determined besides adhesion, infectious disease and trauma. Umbilical hernia should be considered in obese women even without bulging in the umbilicus. Abdominal CT scan with oral water-soluble contrast is preferred as diagnostic tool to identify the cause of small bowel obstruction.
Invisible incarcerated umbilical hernia is possible in obese patients. Routine palpation on potential sites of developing hernia and abdominal CT Scan are necessary to be done in obese patients with small bowel obstruction.
脐疝通常表现为脐部膨出。隐匿性嵌顿性脐疝此前未见报道。
一名53岁肥胖女性，在从其他医院出院一天后因腹痛和呕吐入院，被作为粘连性小肠梗阻保守治疗7天。20年前有剖宫产史。腹部膨隆，下腹部有横行瘢痕伤口，无腹部外疝体征。腹部平片显示扩张的小肠位于腹部中央。行腹部CT扫描以确定除粘连外的其他病因，结果显示为嵌顿性脐疝和胆结石。遂行疝修补术和腹腔镜胆囊切除术。手术中发现一段重要的小肠被困于脐部缺损处。采用梅奥方法关闭缺损。
除粘连、感染性疾病和创伤外，应确定小肠梗阻的其他病因。即使脐部无膨出，肥胖女性也应考虑脐疝。腹部CT扫描加口服水溶性造影剂是诊断小肠梗阻病因的首选工具。
肥胖患者可能发生隐匿性嵌顿性脐疝。对于肥胖的小肠梗阻患者，需对可能发生疝的部位进行常规触诊并进行腹部CT扫描。
