Department of Surgery, Uji-Tokushukai Medical Center, 145 Makishima-cho Ishibashi, Uji, Kyoto, 611-0042, Japan.
Clin J Gastroenterol. 2022 Oct;15(5):941-945. doi: 10.1007/s12328-022-01681-x. Epub 2022 Jul 28.
An 85 year-old woman was transferred with a chief complaint of right thigh pain persisting for 5 days. Abdominal contrast-enhanced computed tomography clearly depicted a swollen appendix incarcerated in the right obturator cavity. She underwent an emergent laparoscopic appendectomy and the simultaneous repair of the obturator hernia. At laparoscopy, appendix was found to be incarcerated in the right obturator canal. The incarcerated appendix was successfully flushed out from the sac by spurting saline into the obturator hernia sac through the catheter inserted into the hernia sac. After a laparoscopic appendectomy, the hernia orifice was repaired using the uterine flap. The patient was discharged from the hospital without any sequelae. This report demonstrates a very rare case of obturator hernia incarcerated with appendix. Although patients with obturator hernia incarcerated with small intestine present with the symptoms related to bowel obstruction, patients with incarceration of appendix do not. Moreover, they would show no typical abdominal symptoms associated with acute appendicitis. Therefore, it is important to perform a radiological evaluation promptly to make a definitive diagnosis when a patient with persisting pain of the right thigh or right ileac fossa with a possibility of obturator hernia with incarceration of the appendix is encountered.
一位 85 岁女性因右大腿疼痛持续 5 天就诊。腹部对比增强 CT 清楚地显示肿胀的阑尾嵌顿于右侧闭孔窝内。患者接受了紧急腹腔镜阑尾切除术和闭孔疝的同时修补术。腹腔镜检查发现阑尾嵌顿于右侧闭孔管内。通过向疝囊内插入的导管向闭孔疝囊内喷射盐水，成功地将嵌顿的阑尾从囊中冲出。阑尾切除术后，使用子宫瓣修补疝口。患者出院时无任何后遗症。本报告展示了一例非常罕见的闭孔疝嵌顿阑尾的病例。虽然闭孔疝嵌顿小肠的患者表现出与肠梗阻相关的症状，但嵌顿阑尾的患者并非如此。此外，他们不会出现与急性阑尾炎相关的典型腹部症状。因此，当遇到有右大腿或右髂窝持续性疼痛、有可能伴有闭孔疝嵌顿阑尾的患者时，及时进行影像学评估以明确诊断非常重要。
