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右侧巨大腹股沟疝

[日期:2013-04-27] 来源:N Engl J Med 2013  作者:Horia Parvanescu, M.D. [字体: ]

     患者,男,67岁,右侧腹股沟区肿物25年,进行性增大。8年余前曾当地医院普外科住院治疗,因考虑的风险性拒绝手术治疗。本次因便秘8天而入院。体查:疝大小55*30cm(疝底部到达膝部),疝巨大,患者随时可能有并发急性肠梗阻,出血或肠扭转的风险。建议患者行手术治疗,但是由于手术风险性,包括肠穿孔,出血和腹壁愈合困难。患者最终选择保守治疗措施,包括高纤维饮食,使用缓泻剂等。患者最终失访。

A 67-year-old man presented with a large right inguinal mass that had progressed in size for 25 years. Eighteen years earlier, he had been hospitalized in a general surgery clinic with an inguinal hernia but declined surgical repair because of concern about the complications associated with the procedure. He returned to the clinic after an 8-day period of constipation. On examination, a hernia, 55 cm in length and 30 cm in width, was noted to reach the level of the knees (Panels A and B). The size of the mass suggested that the patient was at risk for intestinal obstruction, intestinal bleeding, and volvulus. Surgical correction was offered, but because of the risks, including bleeding, intestinal perforation, and failed healing of the abdominal wall, he elected conservative medical management, which included a high-fiber diet and the use of laxatives and enemas. He was subsequently lost to follow-up.
Horia Parvanescu, M.D.
Clinic Emergency Hospital Craiova, Dolj, Romania 
horia_parvanescu@yahoo.com
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