小肠异物致嵌顿性股疝穿孔1例

A Case of Intestinal Foreign Body Causing Perforation of Incarcerated Femoral Hernia

目的:探讨小肠异物致嵌顿性股疝穿孔的临床特点、诊断及治疗。方法:回顾性分析南昌大学第二附属医院胃肠外科2021年2月收治的一名小肠异物致嵌顿性股疝穿孔患者的临床资料。结果:术前盆腔CT提示左侧腹股沟管扩大,部分小肠疝入,其内可见一高密度影。腹腔镜探查发现左股静脉内侧股管处可见小肠肠管疝入,牵拉肠管可见肠管卡压处有长约3 cm鱼刺刺破肠管,嵌顿处肠管可见一圈发黑,术中诊断为“左侧嵌顿性股疝”,予以行“腹腔镜左侧股疝补片修补术 + 小肠部分切除术”,术后恢复顺利,痊愈出院。结论:小肠异物致嵌顿性股疝穿孔,临床上极为少见,术前诊断及术中及时发现异物极为重要,需引起广大临床医师的重视。

Objective: To investigate the clinical features, diagnosis and treatment of enteric foreign bodies with incarcerated femoral hernia. Methods: The clinical data of a patient with intestinal foreign body with incarcerated femoral hernia admitted in Department of gastrointestinal surgery, Second Affiliated Hospital of Nanchang University in February 2021 were analyzed retrospectively. Results: Preoperative pelvic CT showed that the left inguinal canal was enlarged, part of the small intestine was herniated, and a high-density shadow could be seen in it. Laparoscopic exploration found that there was a small intestinal hernia in the femoral tube of the left femoral vein, a fish bone about 3 cm long punctured the intestinal tube at the compression of the intestinal tube at the traction, and a circle of blackening at the incarcerated intestinal tube. During the operation, it was diagnosed as “left incarcerated femoral hernia”, and “laparoscopic left femoral hernia patch repair + partial small bowel resection” was performed. The postoperative recovery was smooth and the patient was discharged. Conclusion: Intestinal foreign body with incarcerated femoral hernia is very rare in clinical practice. Preoperative diagnosis and intraoperative discovery of foreign bodies are very important, which should be paid attention to by clinicians.