Matsuishi Kozue, Saito Seiya, Ohuchi Mayuko, Kiyozumi Yuki, Nasu Jiro, Hanada Norihisa, Baba Hideo
Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan.
Department of Surgery, Izumi General Medical Center, 520 Myozincho, Izumi City, Kagoshima, 899-0131, Japan.
Surg Case Rep. 2023 Oct 16;9(1):178. doi: 10.1186/s40792-023-01746-0.
Internal hernias are relatively rare and difficult to diagnose. Diagnostic delays lead to the progression of strangulation. In particular, pararectal fossa hernias are extremely rare. We encountered a case in which internal hernia occurred in the pararectal fossa.
An 87-year-old woman was referred to our hospital because of persistent lower abdominal pain and vomiting. Contrast-enhanced computed tomography revealed findings of intestinal ischemia, such as closed loop formation with reduced contrast effect on the left side of the rectum in the pelvis. Strangulation small bowel obstruction was diagnosed, and emergency laparotomy was performed. The small intestine was found to invade the peritoneal reflection on the left side of the rectum. The patient was finally diagnosed with pararectal fossa hernia. The incarcerated small intestine was released with no bowel resection. The 4-cm hernia phylum was observed and closed by simple suture. The patient had a good postoperative course without recurrence.
We encountered a very rare case of internal hernia in the left pararectal fossa. Preoperative diagnosis of this disease is difficult, but it should nevertheless be considered in cases in which the cause of the intestinal obstruction is unknown.
内疝相对罕见且难以诊断。诊断延迟会导致绞窄进展。特别是直肠旁窝疝极为罕见。我们遇到了一例发生在直肠旁窝的内疝病例。
一名87岁女性因持续性下腹痛和呕吐被转诊至我院。增强计算机断层扫描显示肠道缺血的表现，如盆腔内直肠左侧出现造影剂增强效果减弱的闭袢形成。诊断为绞窄性小肠梗阻，并进行了急诊剖腹手术。发现小肠侵入直肠左侧的腹膜反折处。患者最终被诊断为直肠旁窝疝。嵌顿的小肠被松解，未进行肠切除。观察到4厘米的疝颈，通过简单缝合进行了闭合。患者术后恢复良好，无复发。
我们遇到了一例非常罕见的左侧直肠旁窝内疝病例。这种疾病术前诊断困难，但在肠梗阻原因不明的病例中仍应考虑到。
