頁籤選單縮合
題 名 | Strangulated Epigastric Hernia Mimicking Abdominal Wall Carbuncle: Report of a Case=絞扼性上腹疝氣以類似腹壁癰表現:病例報告 |
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作 者 | 劉憲; 黃致錕; 游博欽; 謝沛民; 洪朝明; 陳耀森; | 書刊名 | 臺灣外科醫學會雜誌 |
卷 期 | 42:4 2009.07-08[民98.07-08] |
頁 次 | 頁219-223 |
分類號 | 416.2423 |
關鍵詞 | 上腹疝氣; 腹壁癰; Hernias; Epigastric hernia; Abdominal wall; |
語 文 | 英文(English) |
中文摘要 | 上腹疝氣爲白線缺損處之疝氣,爲一不常見之外科疾病,約佔所有腹部疝氣疾病之1.6~3.6%。而上腹疝氣的多種臨床表現,例如膽囊炎、胰臟炎、胃壁膿瘍、消化性潰瘍穿孔、肝絞扼均已有文獻報告,在此我們提出一病例,其絞扼性上腹疝氣以類似腹壁廱表現。一位六十一歲女性患者,因上腹不適及上腹壁紅色腫塊達五至六日而到院治療。初期被診斷爲腹壁癰而轉診至外科。而進一步之影像檢查發現上腹疝氣併小腸嵌頓。在緊急剖腹手術中發現,於上腹白線處有三公分長之筋膜缺損造成疝氣。術中發現十八公分長之小腸已絞扼壞死而進行切除吻合,白線缺損處直接縫合修補。病患術後恢復良好並在手術後十天出院。追蹤四年無發現上腹疝氣復發。這個案例強調上腹疝氣因不常見而可能被誤判爲其他疾病。因有腸道嵌頓之風險,此類疝氣必須儘快正確診斷治療。在腹壁白線處之任何腫塊均須小心檢查,而上腹疝氣必須被考慮爲鑑別診斷之一。 |
英文摘要 | Epigastric hernias occur secondary to herniation via linea alba fascial defects and are clinically uncommon. They are diagnostically challenging to primary care physicians because of their low incidence. Epigastric hernias should be rapidly diagnosed and treated, because their serious complications include bowel incarceration. We herein report a 61-year-old female patient with a strangulated epigastric hernia on clinical presentation. The hernia mimicked a large abdominal wall carbuncle. Further imaging studies confirmed the diagnosis of incarcerated epigastric hernia. In emergent laparotomy, the defect in the linea alba measured 3 cm in diameter and a strangulated small bowel segment which measured 18 cm in length was found inside the hernia sac. Segmental resection of the necrotic small bowel was performed with end-to-end anastomosis. The fascial defect was closed with interrupted sutures. The patient had an uneventful postoperative recovery. No hernia recurrence was noted after 4 years of follow-up. The detailed clinical history and thorough physical examination allowed us to make a differential diagnosis list for all causes of protruding masses along the linea alba. Accordingly, epigastric hernias should always be considered as an important possibility in patients with appropriate clinical signs. |
本系統中英文摘要資訊取自各篇刊載內容。