Tsubono T, Fukuda M, Muto T
Department of Surgery, Sakamachi Hospital, Niigata, Japan.
Surg Today. 1993;23(2):159-63. doi: 10.1007/BF00311235.
A case of bilateral obturator hernias which was diagnosed by ultrasonography (US) and computed tomography (CT), and repaired by a retropubic extraperitoneal operative approach under spinal anesthesia is reported herein. A 91-year-old woman presented with lower abdominal and left groin pain consistent with a Howship-Romberg sign. US demonstrated an image of the bowel projecting from the small pelvic space to the left thigh with a to-and-fro movement of the bowel contents. The definitive diagnosis of an incarcerated left obturator hernia was made by CT which also revealed a mass in the right obturator foramen. Surgery was performed through a retropubic extraperitoneal approach under spinal anesthesia. No necrosis was observed in the incarcerated bowel and resection was not necessary. A simple hernial sac was found in the right obturator canal. The operation using the retropubic extraperitoneal approach was successful and we believe it to be the most effective procedure for obturator hernias which have been diagnosed early.
本文报道了一例经超声（US）和计算机断层扫描（CT）诊断，并在脊髓麻醉下采用耻骨后腹膜外手术方法修复的双侧闭孔疝病例。一名91岁女性，表现为下腹部和左腹股沟疼痛，符合豪希普-龙贝格征。超声显示肠道影像从小盆腔间隙突出至左大腿，肠道内容物有来回移动。CT确诊为左侧嵌顿性闭孔疝，同时还显示右侧闭孔有一肿块。在脊髓麻醉下通过耻骨后腹膜外入路进行手术。嵌顿肠管未观察到坏死，无需切除。在右侧闭孔管发现一个简单的疝囊。采用耻骨后腹膜外入路的手术成功，我们认为这是早期诊断的闭孔疝最有效的手术方法。
