Fujimoto Goshi, Deguchi Takashi, Shirai Junya
Gastroenterological Surgery, Koga Community Hospital, Yaizu, JPN.
Cureus. 2024 May 11;16(5):e60111. doi: 10.7759/cureus.60111. eCollection 2024 May.
External supravesical hernias with ovarian incarceration have not been reported previously. Here, we describe transabdominal preperitoneal (TAPP) repair of an external supravesical hernia with ovarian incarceration. A 68-year-old woman presented to our outpatient clinic with the chief complaint of right inguinal swelling and pain. A 3-cm-diameter mass in the right inguinal region that was difficult to reduce was palpable, and computed tomography (CT) revealed a suspicious lesion of the right hydrocele of the canal of Nuck. Hydrocelectomy was performed through an inguinal incision, and the external inguinal ring was repaired using the Marcy method. The histopathological examination confirmed the diagnosis of the canal of Nuck. Three months postoperatively, the patient again presented with right inguinal pain, and CT revealed a right femoral hernia requiring surgical repair. Intraoperative findings revealed a right external supravesical hernia with an incarcerated ovary, which was laparoscopically reduced and repaired with a mesh. At the three-month follow-up, there were no postoperative complications or recurrences. Incarcerated ovaries with inguinal hernias have been reported in girls; however, incarcerated ovaries with external supravesical hernias have not been reported in women. Although the preoperative diagnosis was difficult to make in this case, the laparoscopic approach led to the diagnosis and successful mesh repair. Although optimal mesh repair of external supravesical hernias using TAPP has not been established, we believe that 2-5 cm around the hernial orifice, the Hesselbach triangle, and the lateral triangle should be covered with mesh.
既往未见有卵巢嵌顿的膀胱上外疝的相关报道。在此，我们描述了一例采用经腹腹膜前（TAPP）修补术治疗的伴有卵巢嵌顿的膀胱上外疝。一名68岁女性因右侧腹股沟肿胀和疼痛为主诉前来我院门诊就诊。可触及右侧腹股沟区一个直径3cm、难以还纳的肿块，计算机断层扫描（CT）显示右侧Nuck管鞘膜积液可疑病变。通过腹股沟切口行鞘膜积液切除术，并采用Marcy法修补腹股沟外环。组织病理学检查确诊为Nuck管病变。术后3个月，患者再次出现右侧腹股沟疼痛，CT显示右侧股疝，需手术修补。术中发现为右侧膀胱上外疝伴卵巢嵌顿，遂通过腹腔镜将其还纳并用补片修补。在3个月的随访中，未出现术后并发症或复发情况。女童腹股沟疝合并卵巢嵌顿的情况已有报道；然而，成年女性膀胱上外疝合并卵巢嵌顿的情况此前未见报道。尽管本例术前诊断困难，但腹腔镜手术实现了诊断并成功进行了补片修补。虽然尚未确立使用TAPP对膀胱上外疝进行最佳补片修补的方法，但我们认为疝孔周围2 - 5cm、海氏三角和外侧三角应使用补片覆盖。
