Miki Y, Sumimura J, Hasegawa T, Mizutani S, Yoshioka Y, Sasaki T, Kamike W, Ito T, Monta O, Nagai I
Department of Surgery, Kinan General Hospital, Tanabe, Wakayama, Japan.
Surg Today. 1998;28(6):652-6. doi: 10.1007/s005950050201.
An 84-year-old woman presented with ileus. Ultrasonography, a computed tomography scan, and small bowel contrast examination showed a Richter-type hernia in her left obturator orifice. Under general anesthesia, laparoscopic surgery with low-pressure (4mmHg) pneumoperitoneum was carried out using a peritoneal needle retractor, and a reduction of the strangulated intestinal loop was thus achieved. Because the hernial opening measured 5mm in diameter, it could be closed with four pieces of End-Universal stapler without polypropylene mesh. The ischemic ileum was resected, and the bowel was anastomosed extracorporeally with a minimal skin incision. She was ambulant on the first postoperative day, and her postoperative course was good. Obturator hernias are rare, but when a definitive diagnosis is made in such elderly patients, laparoscopic repair using the peritoneal needle retractor is recommended for minimally invasive surgery. We recommend doing the repair with an End-Universal stapler, since this procedure is more simple and useful for preventing infection than using polypropylene mesh in such a strangulated case.
一名84岁女性因肠梗阻就诊。超声检查、计算机断层扫描和小肠造影检查显示其左闭孔有Richter型疝。在全身麻醉下，使用腹膜针牵开器进行低压（4mmHg）气腹腹腔镜手术，从而使绞窄的肠袢复位。由于疝孔直径为5mm，可用四枚End-Universal吻合器关闭，无需使用聚丙烯网片。切除缺血的回肠，通过最小的皮肤切口在体外进行肠吻合。术后第一天她即可下床活动，术后恢复良好。闭孔疝较为罕见，但对于此类老年患者一旦确诊，建议使用腹膜针牵开器进行腹腔镜修补以实现微创手术。我们建议使用End-Universal吻合器进行修补，因为在这种绞窄病例中，该方法比使用聚丙烯网片更简单且有助于预防感染。
