2 个月大男婴腹股沟疝的整体缩小术

Pub Date : 2024-03-04 DOI:10.1055/a-2280-9708
Masato Kojima, Ryo Touge, S. Kurihara, Isamu Saeki, Shinya Takahashi
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引用次数: 0

摘要

整体缩窄是指将疝囊缩入腹膜前间隙,疝囊颈部仍有一圈肠管滞留。这种并发症很少见,通常与腹股沟疝有关,其特点是腹股沟没有明显隆起。患者是一名 2 个月大的男孩,左腹股沟出现不可恢复的隆起,诊断为左腹股沟疝嵌顿。经过人工减压,疝气隆起变得不那么明显了。他被收治入院,第二天安排了腹腔镜经皮腹膜外闭合术。腹腔镜检查发现肠道明显扩张、浆液性腹水和左腹股沟处的缺血性肠道。腹腔镜手术显示左腹股沟疝整体缩小,其颈部的回肠被绞窄。我们在颈部做了切口,然后切除了 20 厘米长的绞窄回肠。手术当天患者的情况并不稳定,但术后恢复顺利,术后 11 个月左侧腹股沟疝修补完毕。小儿腹股沟疝大块缩小术非常罕见,但一旦发生,诊断可能会被延误,患者偶尔会有生命危险。为避免大面积疝气还纳术,关键是要轻柔地进行还纳手术,并通过超声波扫描确认腹膜前间隙中没有包含一圈肠管的疝囊。此外,与通常做法不同的是,彻夜观察和密切监测可避免漏诊,从而及时采取干预措施。
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Reduction en masse of inguinal hernia in a 2-month old boy
Reduction en masse is the reduction of the hernial sac into the preperitoneal space, with a loop of bowel remaining trapped at the neck of the hernial sac. This complication is rare, usually associated with inguinal hernias, and is characterized by the absence of a noticeable bulge in the groin. The patient was a 2-month-old boy and presented with a nonreducible bulge in his left groin, and incarceration of the left inguinal hernia was diagnosed. Manual reduction was performed, and the hernia bulge became less noticeable. He was admitted, and laparoscopic percutaneous extraperitoneal closure was scheduled on the next day. The laparoscopy revealed remarkably dilated intestines, serous ascites, and an ischemic intestine in the left groin. A laparotomy was performed and revealed reduction en masse of the left inguinal hernia with a strangulated ileum at its neck. We made an incision at the neck, followed by the resection of 20 cm long the strangulated ileum. The patient’s condition was unstable on the day of operation, but the postoperative period was uneventful and the left inguinal hernia was repaired, 11 months after the operation. Reduction en masse in pediatrics is significantly rare but when it occurs, the diagnosis can be delayed and occasionally the patient will be life-threatening. To avoid reduction en masse, it is crucial to perform the reduction gently and confirm the absence of a hernia sac in the preperitoneal space containing a loop of bowel by ultrasound scanning. Moreover, contrary to common practice, overnight observation and close monitoring will avoid missing a late presentation, leading to timely interventions.
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