PDF(Pubmed)
Abstract：
BACKGROUND: Most colon cancers that develop in the intestinal tract within the inguinal hernia sac are identified by incarceration. However, treatment methods for these cases vary depending on the pathology. Cases showing perforation or abscess formation require emergency surgery for infection control, while cases with no infection generally involve oncological resection, with laparoscopic surgery also being an option. We encountered a case of Incomplete bowel obstruction secondary to sigmoid colon cancer within the hernial sac. We report the process leading to the selection of the treatment method and the surgical technique, along with a review of the literature.
METHODS: A 79-year-old man presented to our hospital complaining of a left inguinal bulge (hernia) and pain in the same area. The patient had the hernia for more than 20 years. Using computed tomography, we diagnosed an incomplete bowel obstruction caused by a tumor of the intestinal tract within the hernial sac. Since imaging examination showed no signs of strangulation or perforation, we decided to perform elective surgery after a definitive diagnosis. After colonoscopy, we diagnosed sigmoid colon cancer with extra-serosal invasion; however, we could not insert a colorectal tube. Although we proposed sigmoid resection and temporary ileostomy, we chose the open Hartmann procedure because the patient wanted a single surgery. For the hernia, we simultaneously used the Iliopubic Tract Repair method, which does not require a mesh. Eight months after the surgery, no recurrence of cancer or hernia was observed.
CONCLUSIONS: We report a case of advanced sigmoid colon cancer with a long-standing inguinal hernia that later became incomplete bowel obstruction. Although previous studies have used various approaches among the available surgical methods for cancer within the hernial sac, such as inguinal incision, laparotomy, and laparoscopic surgery, most hernias are repaired during the initial surgery using a non-mesh method. For patients with inguinal hernias that have become difficult to treat, the complications of malignancy should be taken into consideration and the treatment option should be chosen according to the pathophysiology.
METHODS: A 79-year-old man presented to our hospital complaining of a left inguinal bulge (hernia) and pain in the same area. The patient had the hernia for more than 20 years. Using computed tomography, we diagnosed an incomplete bowel obstruction caused by a tumor of the intestinal tract within the hernial sac. Since imaging examination showed no signs of strangulation or perforation, we decided to perform elective surgery after a definitive diagnosis. After colonoscopy, we diagnosed sigmoid colon cancer with extra-serosal invasion; however, we could not insert a colorectal tube. Although we proposed sigmoid resection and temporary ileostomy, we chose the open Hartmann procedure because the patient wanted a single surgery. For the hernia, we simultaneously used the Iliopubic Tract Repair method, which does not require a mesh. Eight months after the surgery, no recurrence of cancer or hernia was observed.
CONCLUSIONS: We report a case of advanced sigmoid colon cancer with a long-standing inguinal hernia that later became incomplete bowel obstruction. Although previous studies have used various approaches among the available surgical methods for cancer within the hernial sac, such as inguinal incision, laparotomy, and laparoscopic surgery, most hernias are repaired during the initial surgery using a non-mesh method. For patients with inguinal hernias that have become difficult to treat, the complications of malignancy should be taken into consideration and the treatment option should be chosen according to the pathophysiology.
摘要：
背景：在腹股沟疝囊内的肠道中发展的大多数结肠癌通过嵌顿被鉴定。然而,这些病例的治疗方法因病理而异。显示穿孔或脓肿形成的病例需要紧急手术控制感染，虽然没有感染的病例通常涉及肿瘤切除术，腹腔镜手术也是一种选择。我们在疝囊内遇到一例乙状结肠癌继发的不完全肠梗阻。我们报告了导致选择治疗方法和手术技术的过程，以及文献综述。
方法：一名79岁的男子到我们医院就诊，抱怨左侧腹股沟隆起（疝）和同一区域疼痛。患者患有疝气超过20年。用计算机断层扫描,我们诊断为由疝囊内的肠道肿瘤引起的不完全性肠梗阻。由于影像学检查显示没有绞窄或穿孔的迹象，明确诊断后,我们决定进行择期手术.结肠镜检查后，我们诊断为乙状结肠癌伴浆膜外浸润；然而，我们无法插入结直肠管.尽管我们提出了乙状结肠切除术和临时回肠造口术，我们选择了开放的Hartmann手术，因为病人想要一个单一的手术。对于疝气，我们同时使用了耻骨尿道修复法,它不需要网格。手术八个月后,未观察到癌症或疝气复发。
结论：我们报告一例晚期乙状结肠癌合并长期腹股沟疝，后来变成不完全性肠梗阻。尽管以前的研究已经在可用的手术方法中使用了各种方法来治疗疝囊内的癌症，如腹股沟切口，剖腹手术,和腹腔镜手术，大多数疝在初始手术期间使用非网状方法进行修复。对于已经变得难以治疗的腹股沟疝患者，应考虑恶性肿瘤的并发症，并根据病理生理选择治疗方案。
方法：一名79岁的男子到我们医院就诊，抱怨左侧腹股沟隆起（疝）和同一区域疼痛。患者患有疝气超过20年。用计算机断层扫描,我们诊断为由疝囊内的肠道肿瘤引起的不完全性肠梗阻。由于影像学检查显示没有绞窄或穿孔的迹象，明确诊断后,我们决定进行择期手术.结肠镜检查后，我们诊断为乙状结肠癌伴浆膜外浸润；然而，我们无法插入结直肠管.尽管我们提出了乙状结肠切除术和临时回肠造口术，我们选择了开放的Hartmann手术，因为病人想要一个单一的手术。对于疝气，我们同时使用了耻骨尿道修复法,它不需要网格。手术八个月后,未观察到癌症或疝气复发。
结论：我们报告一例晚期乙状结肠癌合并长期腹股沟疝，后来变成不完全性肠梗阻。尽管以前的研究已经在可用的手术方法中使用了各种方法来治疗疝囊内的癌症，如腹股沟切口，剖腹手术,和腹腔镜手术，大多数疝在初始手术期间使用非网状方法进行修复。对于已经变得难以治疗的腹股沟疝患者，应考虑恶性肿瘤的并发症，并根据病理生理选择治疗方案。
