Su Jin, Deng Cheng, Yin Hui-Ming
Department of General Surgery, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College of Central South University, Zhuzhou 412000, Hunan Province, China.
Division of Science and Education, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College of Central South University, Zhuzhou 412000, Hunan Province, China.
World J Clin Cases. 2022 Mar 16;10(8):2637-2643. doi: 10.12998/wjcc.v10.i8.2637.
Drain-site hernia (DSH) has an extremely low morbidity and has rarely been reported. Small bowel obstruction is a frequent concurrent condition in most cases of DSH, which commonly occurs at the ≥ 10 mm drain-site. Here we report a rare case of DSH at the lateral 5 mm port site one month postoperatively without visceral incarceration. Simultaneously, a brief review of the literature was conducted focusing on the risk factors, diagnosis, and prevention strategies for DSH.
A 76-year-old male patient was admitted to our institution with intermittent abdominal pain and a local abdominal mass which occurred one month after laparoscopic radical resection of rectal cancer one year ago. A computed tomography scan showed an abdominal wall hernia at the 5 mm former drain-site in the left lower quadrant, and that the content consisted of the large omentum. An elective herniorrhaphy was performed by closing the fascial defect and reinforcing the abdominal wall with a synthetic mesh simultaneously. The postoperative period was uneventful. The patient was discharged seven days after the operation without surgery-related complications at the 1-mo follow-up visit.
Emphasis should be placed on DSH despite the decreased use of intra-abdominal drainage. It is recommended that placement of a surgical drainage tube at the ≥ 10 mm trocar site should be avoided. Moreover, it is advisable to have a comprehensive understanding of the risk factors for DSH and complete closure of the fascial defect at the drainage site for high-risk patients.
引流部位疝（DSH）发病率极低，鲜有报道。小肠梗阻是大多数DSH病例常见的并发情况，通常发生在引流口≥10 mm处。本文报告1例罕见的术后1个月在外侧5 mm穿刺孔部位发生的DSH，无内脏嵌顿。同时，对DSH的危险因素、诊断及预防策略进行了简要文献复习。
一名76岁男性患者因间歇性腹痛和局部腹部肿块入院，该情况发生在1年前腹腔镜直肠癌根治术后1个月。计算机断层扫描显示左下腹5 mm原引流部位腹壁疝，疝内容物为大网膜。行择期疝修补术，同时关闭筋膜缺损并用合成补片加强腹壁。术后恢复顺利。术后7天出院，1个月随访时无手术相关并发症。
尽管腹腔引流的使用有所减少，但仍应重视DSH。建议避免在≥10 mm的套管针部位放置手术引流管。此外，建议全面了解DSH的危险因素，并对高危患者在引流部位完全关闭筋膜缺损。
