背景:腹部疝,包括切口疝,可能是由于腹壁无力而发生的。切口疝通常发生在手术切口后,闭合技术差和患者相关因素等因素可能导致其发展。
方法:在这种情况下,病人出现了疼痛,先前剖腹手术疤痕上的不可还原肿块,伴有肠梗阻症状.超声检查结果支持诊断,显示疝囊中的肠环阻塞。行急诊开放手术复位和网片修补术治疗绞窄疝,确保母亲和胎儿的安全。患者术后时间顺利,三天后出院。
结论:切口疝可以通过临床评估来诊断,在复杂的病例中,影像学检查可能是必要的。然而,由于存在辐射风险,诸如X射线和计算机断层扫描之类的成像技术在孕妇中受到限制。超声检查(USS)因其安全性和非侵入性而在孕妇中首选,尽管它可能会降低肥胖患者的敏感性。复杂的疝应进行紧急手术修复,而择期手术可以考虑无症状或非复杂性疝。腹腔镜手术具有缩短住院时间和减少并发症等优点。网眼修复可降低后续妊娠的复发风险(与病例讨论相关)。
结论:总体而言,妊娠期疝气的手术治疗需要仔细考虑个体情况,并使用适当的技术来确保母亲和胎儿的安全。
BACKGROUND: Abdominal hernias, including incisional hernias, can occur due to weakness in the abdominal wall. Incisional hernias commonly occur following surgical incisions, and factors such as poor closure technique and patient-related factors can contribute to their development.
METHODS: In this
case, the patient was presented with a painful, irreducible lump over a previous laparotomy scar, along with bowel obstruction symptoms. The diagnosis was supported by ultrasound findings showing obstructed bowel loop in the hernial sac. Emergency open surgical reduction and mesh repair were performed to treat the strangulated hernia and ensure the mother and fetus\'s safety. The patient had an uneventful postoperative period and was discharged after three days.
CONCLUSIONS: Incisional hernias can be diagnosed through clinical evaluation, and imaging studies may be necessary in complex cases. However, imaging techniques such as X-rays and Computed Tomography scans are limited in pregnant women due to the radiation risks. Ultrasonography (USS) is preferred in pregnant women for its safety and non-invasiveness, although it may have reduced sensitivity in obese patients. Complicated hernias should be treated with emergency surgical repair, while elective surgery can be considered for asymptomatic or non-complicated hernias. Laparoscopic surgery offers advantages such as shorter hospital stays and fewer complications. Mesh repair reduces the recurrence risk in subsequent pregnancies (relate the discussion with the
case).
CONCLUSIONS: Overall, surgical management of hernias in pregnancy requires careful consideration of individual circumstances and the use of appropriate techniques to ensure the safety of both the mother and fetus.