Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, London, UK.
Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, London, UK
BMJ Case Rep. 2023 Dec 21;16(12):e254637. doi: 10.1136/bcr-2023-254637.
Pregnancy complicated by incisional hernia is rare but can become an obstetric challenge if the gravid uterus becomes displaced or incarcerated into the hernial sac or if there is ulceration of the overlying dermis as a result of increased intra-abdominal pressure being transmitted to the skin. We report a case of a pregnant woman presenting with a large incisional hernia at 19 weeks of gestation and discuss how problems encountered with progressing pregnancy were managed conservatively by adopting a multidisciplinary team approach (which included surgeons and radiologists). She underwent a caesarean section at 35 weeks of gestation due to active bleeding from the ulcerated skin and foetal growth restriction with subsequent staged secondary hernia repair at a tertiary centre. Close surveillance is mandatory, and a decision on the mode and timing of delivery as well as when to perform the surgical repair of the fascial defect should be team based.
妊娠合并切口疝罕见，但如果子宫移位或嵌顿于疝囊内，或因腹壁内压力增加传递至皮肤导致覆盖真皮层溃疡，可能会成为产科挑战。我们报告了一例 19 周妊娠的孕妇出现巨大切口疝，讨论了如何通过多学科团队方法（包括外科医生和放射科医生）保守治疗进展性妊娠中遇到的问题。由于溃疡皮肤出血和胎儿生长受限，她在 35 周妊娠时行剖宫产术，随后在三级中心分期行二期疝修补术。必须进行密切监测，并应根据团队的决策决定分娩方式和时间以及何时进行筋膜缺损的手术修复。
