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例 1:女性 ,5 5岁。因反复腹痛并右侧大腿内侧疼痛 2年 ,复发 6h于 1995年入院。疼痛发作时伴有恶心、呕吐 ,无明显畏寒、发热 ,无肛门停止排便排气。查体 :消瘦 ,伸髋关节时疼痛加重 ,且向大腿内侧、窝放射。诊断为右侧闭孔疝。手术时腹痛已消失。手术证实为右侧闭孔疝 ,经腹腔内修补 ,术中见左侧闭孔也较大 ,但因左侧未出现过症状 ,故未作修补。术后 2年 ,患者又出现腹痛并左侧窝后放射 ,再次就诊 ,结合以前病史 ,诊断左侧闭孔疝。手术见右侧修补完好。行左侧修补术 ,术后随访 3年无腹痛发作。例 2 :女性 ,71岁。因反复腹痛 3年 ,复… 相似文献
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目的探讨闭孔疝的临床特点,提高其诊断和治疗水平。方法对我院2004年1月至2008年12月收治的9例闭孔疝患者的临床资料、诊断和治疗作回顾性分析。结果术前确诊2例,确诊率22.22%,全部为单侧闭孔疝,疝内容物全部为小肠,4例发生肠坏死,行坏死肠管切除术,8例行补片修补闭孔,1例经腹外修补。8例治愈出院,1例术后死于吻合口瘘、感染性休克。8例随访至今无复发。结论闭孔疝发病率低,误诊率及病死率均高。多发于年老、消瘦、多孕多胎生育史的女性。Howship—Romberg征和CT检查有助于其诊断;对高度怀疑本病者果断剖腹探查,能降低本病病死率。 相似文献
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目的总结闭孔疝的临床诊断、治疗及手术经验。方法回顾性分析笔者所在医院2010年7月至2012年7月期间收治的5例闭孑L疝患者的临床资料。结果5例患者查体时4例具有明确的Howship—Romberg征,均未发现Hannington—Kiff征。4例术前行腹部立卧位X线平片提示肠梗阻,1例提示不全性肠梗阻。5例均行腹部及盆腔CT平扫,仅1例怀疑病变侧可疑疝囊影像。术前均未确诊,均行剖腹探查,术中证实患者均为单侧闭孔疝嵌顿,嵌顿物为小肠,且所嵌顿小肠均已坏死,遂行坏死肠段切除、闭孔内口处缝扎疝囊颈。术后并发肺部感染3例,肠瘘1例;痊愈4例,死亡1例,死亡原因为肺部感染及肠瘘。5例患者的平均住院时间为10.5d(5~14d)。存活的4例患者均随访12个月,无复发。结论闭孔疝的临床表现不典型,对于年老、体弱的患者,出现不明原因肠梗阻,且伴有明确的Howship—Romberg征时应该高度怀疑该病的可能。早期诊断和早期手术是提高闭孔疝患者生存率的有效手段。 相似文献
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闭孔疝的诊断和治疗 总被引:5,自引:0,他引:5
目的探讨闭孔疝的诊治方法。方法对15例闭孔疝病例诊治经过结合相关文献进行回顾性分析。结果15例中.术前确诊率仅20%(3/15),误诊率80%(12/15),全组均行疝环修补术,采用剖腹探查切口。本组治愈率100%,术后切口感染及愈合不良4例(21.67%),随访8例至今无复发。结论术前易误诊、漏诊;对年老体弱、多胎生育伴有不明原因肠梗阻表现的妇女,应高度考虑闭孔疝,Howship—Romberg征及Hannington—Kiff征阳性可确诊。疝环修补术是惟一有效的方法,首选腹腔内入路。早确诊.及时手术是减少并发症、降低死亡率的关键。 相似文献
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Nicholas Hodgins Krzysztof Cieplucha Padhraic Conneally Essam Ghareeb 《International journal of surgery case reports》2013,4(10):889-892
INTRODUCTIONAn obturator hernia is a rare condition but is associated with the highest mortality of all abdominal wall hernias. Early surgical intervention is often hindered by clinical and radiological diagnostic difficulty. The following case report highlights these diagnostic difficulties, and reviews the current literature on management of such cases.PRESENTATION OF CASEWe present the case of an 86-year-old lady who presented with intermittent small bowel obstruction, clear hernial orifices, and right medial thigh pain. Pre-operative CT imaging was suggestive of an obstructed right femoral hernia. However, intra-operatively the femoral canal was clear and an obstructed hernia was found passing through the obturator foramen lying between the pectineus and obturator muscles in the obturator canal.DISCUSSIONObturator hernias are notorious for diagnostic difficulty. Patients often present with intermittent bowel obstruction symptoms due to a high proportion exhibiting Richter's herniation of the bowel. Hernial sacs can irritate the obturator nerve within the canal, manifesting as medial thigh pain, and often no hernial masses can be detected on clinical examination. Increasing speed of diagnosis through early CT imaging has been shown to reduce the morbidity and mortality associated with obturator hernias. However, over-reliance on CT findings should be cautioned, as imaging and operative findings may not always correlate.CONCLUSIONA high suspicion for obturator hernia should be maintained when assessing a patient presenting with bowel obstruction particularly where intermittent symptoms or medial thigh pain are present. Rapid clinical and appropriate radiological assessment, followed by early surgery is critical to successful treatment. 相似文献
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Sanjeev R. Kulkarni Aditya R. Punamiya Ramchandra G. Naniwadekar Hemant B. Janugade Tejas D. Chotai T. Vimal Singh Arafath Natchair 《International journal of surgery case reports》2013,4(7):606-608
INTRODUCTIONObturator hernia is an extremely rare type of hernia with relatively high mortality and morbidity. Its early diagnosis is challenging since the signs and symptoms are non specific.PRESENTATION OF CASEHere in we present a case of 70 years old women who presented with complaints of intermittent colicky abdominal pain and vomiting. Plain radiograph of abdomen showed acute dilatation of stomach. Ultrasonography showed small bowel obstruction at the mid ileal level with evidence of coiled loops of ileum in pelvis. On exploration, Right Obstructed Obturator hernia was found. The obstructed Intestine was reduced and resected and the obturator foramen was closed with simple sutures. Postoperative period was uneventful.DISCUSSIONObturator hernia is a rare pelvic hernia and poses a diagnostic challenge. Obturator hernia occurs when there is protrusion of intra-abdominal contents through the obturator foramen in the pelvis. The signs and symptoms are non specific and generally the diagnosis is made during exploration for the intestinal obstruction, one of the four cardinal features. Others are pain on the medial aspect of thigh called as Howship Rombergs sign, repeated attacks of Intestinal Obstruction and palpable mass on the medial aspect of thigh.CONCLUSIONObturator hernia is a rare but significant cause of intestinal obstruction especially in emaciated elderly woman and a diagnostic challenge for the Doctors. CT scan is valuable to establish preoperative diagnosis. Surgery either open or laproscopic, is the only treatment. The need for the awareness is stressed and CT scan can be helpful. 相似文献
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Obturator hernia 总被引:2,自引:0,他引:2
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Four cases of strangulated obturator hernia are presented with a brief review of the literature up to 1980. All four patients were emaciated women over 50 years old and in all instances the hernia was on the left side. None of the cases was diagnosed preoperatively and all had Howship-Romberg's sign absent. A diagnosis of strangulated obturator hernia should always be considered in any elderly, thin female with clinical features of intestinal obstruction and without any history of previous abdominal operations. Three of the patients died due to delayed presentation, delayed operative interference and rupture of the gangrenous loop leading to septicaemia. 相似文献
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