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De Garengeot疝

[日期:2013-05-06] 来源:N Engl J Med. 2009  作者:Augustine Chung, B.A., and Amitabh Goel, M.D [字体: ]
     83岁女性,主诉右侧腹股沟区包块伴疼痛1周,进行性增大。体检:右侧腹股沟区广泛发红,触痛,局部包块延伸至右侧阴唇。探查右侧腹股沟区,发现局部脓肿,将其引流。股管内可见坏死组织。选择脐下腹部切口,术中发现股管内坏死组织为阑尾远端。De Garengeot's疝在1731年首次被提及,即股疝疝囊内为阑尾,这比首例有记载的阑尾切除术还早了5年。该疝容易误诊为嵌顿或较窄性股疝。与Amyand疝有明显区别(Amyand疝阑尾存在于腹股沟管疝囊内)。该病例中,我们行开放阑尾切除术,疝一期修补。术后随访伤口一期愈合。(Translated by YB)


Images in clinical medicine. De Garengeot's hernia.
Chung A, Goel A.
Case Western Reserve University, Cleveland, OH 44106, USA.
N Engl J Med. 2009 Sep 10;361(11) 

An 83-year-old woman presented with a 1-week history of an enlarging, painful bulge in the right groin. Examination of the abdomen revealed a diffusely tender and erythematous rightgroin mass extending to the right labium (Panel A). The examination was otherwise unremarkable. Onexploration of the right groin, an abscess was found and drained, and necrotic tissue was observed within the femoral canal. An infraumbilical abdominal incision was made. The appendix, with a necrotic distal portion (Panel B), was found within the femoral canal. The presence of a vermiform appendix in a femoral hernia sac, termed de Garengeot's hernia, was first described in 1731, which was 5 years before the first reported appendectomy. De Garengeot's hernia is often misdiagnosed as an incarcerated or strangulated femoral hernia. It is distinct from Amyand's hernia, in which the appendix is within an inguinal hernia sac. In this case, we performed an open appendectomy, and the hernia was primarily closed. Full wound closure was noted during a follow-up visit. 
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