原发性大网膜扭转误诊阑尾周围脓肿1例报道

<正>病例资料患者,男,42岁,因"持续性下腹部疼痛3 d,伴发热1 d"急诊入院。患者于入院前3 d重体力劳动后出现腹痛,呈持续隐痛,以脐周、下腹明显,伴有恶心及轻度腹胀。入院前1 d上述症状加重,伴发热,体温未测,呕吐,停止排便,精神差。入院查体:T 39.2℃,R 24次/min,P 130次/min,BP 162/106 mm Hg(1 mm Hg=0.133 k Pa),体质量92 kg。     

腹腔镜术后阑尾粪石遗漏腹壁内1例报告

<正>患者男,30岁,因"右下腹部包块伴疼痛半月"入院。患者半月前无意中发现右下腹部包块,伴持续性钝痛,无恶心、呕吐、畏寒、发热。患者2年前因急性阑尾炎于当地医院行腹腔镜阑尾切除术(laparoscopic appendectomy,LA)。体检腹部见三孔法阑尾切除术的切口疤痕,右侧腹平脐水平约1 cm切口疤痕,下方有约8 cm×3 cm包块,压痛,边界不清,不活动。于当地医院行CT检查,提示右侧腹部腹壁下方(约平脐水平)见不规则形混杂密度,增强扫描明显不均匀强化,符合感染表现。结合患者     

老年膈疝嵌顿致绞窄性肠梗阻一例

患者，女，72岁。因腹痛伴停止排气、排便3d入院。3d前患者无明显诱因出现阵发性腹痛，先为脐周疼痛，继之出现右上腹持续疼痛，伴腹胀，呕吐胃内容物，并停止排气、排便，在当地医院给予肌注阿托品及静脉用药治疗无效转入我院。     

先天性双卵黄管纤维索带致绞窄性肠梗阻一例

患者男，２０岁。右下腹疼痛８h，伴呕吐，于１９９９年７月２９日以急性阑尾炎收入院。患者因饱餐后出现右下腹、脐周及腰背部持续性闷胀痛，疼痛剧烈，呈进行性加重，伴恶心、频繁呕吐（呕吐物为胃内容物），肛门停止排气排便。既往于幼年时曾有脐周疼痛发作史及右腹股沟斜疝     

外伤致腹股沟斜疝囊内小肠破裂1例

患者男性,60岁。因右大腿根部撞伤伴疼痛3h急诊入院。患者右侧腹股沟可复性肿物已有8个月。3h前搬运物体时不慎撞伤右大腿根部,出现被撞击部位疼痛,平卧后被撞伤处疼痛减轻,半小时后出现下腹部疼痛,并逐渐加重,无发热,伴有恶心,无呕吐。     

腹膜后阑尾周围脓肿并侧腹壁及阴囊坏死性筋膜炎死亡一例

患者男性．21岁。因“腹痛6d,加重2d”于2010年4月3日入院。患者6d前无明显诱因出现腹痛．始于上腹部,后扩散至右下腹,疼痛程度以下腹部为著;伴纳差、无恶心呕吐。在当地医院抗感染治疗后稍好转。2d前出现腹痛加重,伴腹胀,肛门停止排气、排粪,右侧腹股沟及阴囊肿胀疼痛。     

肠结核合并急性阑尾炎1例

患者男性,37岁,因“转移性右下腹部疼痛1天”于2011年3月11日就诊.患者无任何诱因出现脐周部疼痛,呈持续性,无发热,恶心伴呕吐1次,非喷射状,呕吐物为胃内容物,无腹泻、腹胀等症状,脐周疼痛约5h后疼痛转移并局限在右下腹部.     

乙状结肠间疝一例

患者　男性 ,6 3岁 ,阵发性腹痛伴停止排气、排便 4d于2 0 0 4年 3月 2 3日入院。患者有右侧腹股沟疝手术史。查体 :体温 36 8℃ ,腹膨隆 ,脐周可见肠形及蠕动波 ;下腹部压痛 ,以左下腹为甚 ,无反跳痛及肌紧张 ,未扪及包块 ;肠鸣音亢进 ,可闻及气过水声。腹部平片提示 :小肠梗阻。查外周血常规 :白细胞 19 2× 10 9/L ,中性 0 92。入院后予胃肠减压、抗感染、输液治疗 3d后 ,肠梗阻无缓解于 3月 2 6日在硬膜外麻醉下行剖腹探查术 ,术中见小肠明显扩张 ,距回盲部约 5 0cm处末端回肠与乙状结肠关系紧密不能提起 ,且乙状结肠后方可扪及一 6c…     

双侧闭孔疝同时性嵌顿一例

患者女,65岁,因腹痛、腹胀伴肛门停止排气排便不畅4d入院。以下腹部及脐周疼痛为主,呈持续性胀痛,无阵发性加剧,不伴恶心、呕吐,无发热。既往无类似发作史,无其他疾病史记载,无手术史。门诊腹部X线透视提示肠梗阻。入院查体：T35．7℃,BP125／85mmHg（1mmHg：0．133kPa）,一般情况可,皮肤黏膜无黄染,心肺未闻及异常,腹部明显膨隆胀气,未见肠型,全腹肌软,脐周及下腹部压痛,无反跳痛,未触及包块,叩诊鼓音,肠鸣音亢进,可闻及气过水声,双侧腹股沟区未见异常。入院诊断：急性机械性小肠梗阻,考虑为粘连、肿瘤、肠扭转可能。     

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病人男,20岁。因反复右下腹痛6年,加重1d,于2005年平均增长月27日入院。病人6年前无诱因出现右下腹阵发性隐痛,疼痛时右下腹可触及3cm×3cm大小包块,可持续数分钟,伴轻度腹胀,疼痛可以自行缓解,包块随即消失。疼痛无放散,无恶心呕吐和发热。入院前1天出现脐周疼痛,后转为右下腹     

腹股沟疝 UHS 手术

超普疝修补装置（ ULTRAPRO Hernia System, UHS）由上片、下片和中间连接柱构成。下片位于腹膜与腹横筋膜之间（腹膜前间隙）,覆盖整个肌耻骨孔,起到了腹膜前间隙修补的作用;将上片分别固定于腹股沟韧带和耻骨结节,加强腹股沟管后壁;中间连接柱既充填了疝环缺损,又连接和稳定了上、下片,可防止网片移位造成的复发。 UHS同时对腹膜前间隙和腹股沟管后壁进行双重修补,理论上最大限度地减少了腹股沟疝的复发。     

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自Ｂassini首创疝修补术以来,至今已有１００余年历史。尽管其总体疗效尚称满意,但有关各术式的立论依据及其适应证一直有着争论,疝修补的术后复发和并发症仍存在问题。据报道,初发腹股沟疝的术后复发率约为１０％,而复发性疝可高达２０％,总的并发症发生率也在７％－１２％之间。因此,如何提高腹外疝手术的成功率,降低术后并发症发生率,是临床外科亟待解决的课题。     

无张力疝修补术与传统疝修补术治疗腹股沟疝的疗效分析

目的探讨无张力疝修补术与传统疝修补术治疗腹股沟疝的疗效,为基层医院的治疗提供参考。方法将86例患者按照随机原则分为观察组与对照组,每组43例,观察组采用无张力疝修补术进行治疗,对照组采用传统疝修补术进行治疗,比较两组患者的手术时间、住院时间、住院费用、术后恢复时间、并发症及复发情况。结果两组患者的手术时间比较,差异无统计学意义（P〉0.05）;两组患者的住院时间、术后恢复时间、住院费用比较,差异有统计学意义（P〈0.05）。两组患者的并发症发生率,观察组为30.2%,对照组为58.1%,两组比较,差异有统计学意义（P〈0.05）。两组患者的复发率对照组为18.6%、观察组为2.3%,两组比较,差异有统计学意义（P〈0.05）。结论无张力疝修补术操作简单、复发率低、并发症少,易为患者接受,较适合在基层医院推广应用。     

Intrascrotal hernia of the ureter and fatty hernia

Intrascrotal hernia of the ureter is a rare event. We describe here one such case. There are two anatomic types of such ureteral hernias. The paraperitoneal type has a peritoneal indirect sac, which pulls the ureter with it. The extraperitoneal ureteral hernia is without a peritoneal sac. In such cases, which are almost always indirect hernias, there is usually a large amount of fat. It is, in fact, retroperitoneal fat, which slides, and pulls the ureter with it by gravity. Such a case is a genuine prolapse of the retroperitoneal structures. This anomaly, which has been rarely studied, is worth knowing about, because the ureter may be damaged during hernia dissection. The surgeon should be cautious when discovering huge fatty hernias, and should avoid the excision of fat and simply return the fatty mass to its normal place after its separation from the cord. Electronic Publication     

Umbilical hernia repair with the prolene hernia system

BACKGROUND: Despite its extensive application for the repair of inguinal hernias, the use of the Prolene Hernia System (PHS; Ethicon, West Somerville, NJ) for the repair of umbilical hernias has been sparse. The purpose of this prospective study was to assess, in comparison with currently available techniques, the effectiveness of the PHS in repairing umbilical hernias. METHODS: Fifty consecutive patients diagnosed with a primary umbilical hernia were enrolled for the study. They were randomized and underwent elective repair of umbilical hernia using either the PHS (n = 17), Mayo repair (n = 18), or onlay repair with mesh (n = 15). Data for the time required for the surgical repair method, length of hospital stay, postoperative pain, analgesic necessity, and return to work, and early and late complications were recorded, and compared with respect to the repair procedure. RESULTS: The mean operating time and the mean length of hospital stay were the longest in the onlay repair with mesh group (P < .05). Those patients operated on using the PHS described minimum pain on the postoperative first , second, and seventh days (P < .05) and also the necessity of analgesic was significantly lower in this group (P < .05). There were 2 recurrences in Mayo repair group. The mean follow-up duration was 22 months (range 6 to 44 months). CONCLUSION: The PHS seemed to be useful for umbilical hernia repairs in selected patients as it caused minimal postoperative pain and less analgesic necessity.     

Spigelian hernia presenting as an incarcerated incisional hernia

Summary Spigelian hernia, first described at the 18th century, is a rare ventral abdominal hernia occuring through the spigelian fascia. The diagnosis is difficult especially when there is no palpable mass. The case presented here had a spigelian hernia mimicking an incarcerated incisional hernia. This patient had undergone an appendectomy through a right paramedian incision proviously. Three years later she was operated for a suspected incisional hernia. Exploration did not reveal any defects in the external oblique aponeurosis so no further exploration was done. Our operative findings showed also an intact external oblique aponeurosis but when incised a spigelian hernia was observed beneath this structure, which was repaired promptly. A high index of suspicision is necessary for diagnosis both pre and intraoperatively.     

Indirect inguinal hernia masquerading as a Spigelian hernia

Inguinal hernia usually developed and descended into scrotum. The clinical presentation is inguinal or inguino-scrotal swelling. Abdominal wall weakness as it is frequently seen in African tropical zones produces often rare clinical case. We report a case of inguinal hernia presented as an abdominal wall swelling clinically suggestive of a Spigelian hernia and discuss the mechanism.     

Operation hernia: humanitarian hernia repairs in Ghana

Ghana has a high incidence of inguinal hernias and the healthcare system is unable to deliver an adequate repair rate. This results in morbidity and mortality and has a knock-on effect on the local economy. A project has been set up to try and reduce the burden of these hernias by establishing Africa’s first Hernia Centre. This is supported by structured visits by European surgeons to the centre. In October 2006, a team of four surgeons, two specialist registrars, one hernia nurse specialist, and three nurses was assembled in order to open the Hernia Centre, which will provide a base for the delivery of hernia services in the West of Ghana. A 2-year teaching programme has been formulated, tailored to the needs of local surgeons and nurses, with the aim of developing an integrated team that will initially deliver up to 50 hernia repairs each month. It is planned that the centre will be supported by structured periodic visits from surgeons and nurses based in Plymouth, the European Hernia Society, and any other volunteers wishing to support the link.