背景:整体减少(REM)是一种罕见的情况,在手动腹股沟疝(IH)减少后,疝囊被减少回腹膜前间隙,肠环嵌顿在囊的颈部。它类似于成功的手动还原,因此很容易被忽略。我们在此报告了一例通过腹腔镜成功治疗的IH的REM婴儿病例。
方法:一名10个月大的男孩,在4个月大的时候有双侧开放性IH修复手术史,他的左腹股沟有隆起和呕吐。怀疑是左监禁复发性IH,并进行手动复位。疝气显然被成功地减少了,但腹胀和呕吐持续存在。他因症状入院接受进一步观察。入院后第2天,腹部X线片显示广泛的小肠梗阻(SBO)。增强的计算机断层扫描(CT)显示小肠突出,左腹股沟呈闭环。怀疑由于术后粘连或内部疝引起的闭环SBO。为了评估SBO的病因,计划紧急腹腔镜探查疝修补术。腹腔镜检查显示左嵌顿IH的REM,囊颈部腹膜增厚。进行了腹腔镜复位术,嵌顿的小肠没有缺血的迹象。疝囊与先前的阴道结扎过程无关,这是由以前的Potts程序关闭的。它位于阴道突起的内部。通过腹腔镜经皮腹膜外闭合手术成功闭合囊,髂耻骨束修复也通过先前的腹股沟切口进行。术后病程顺利。
结论:小儿IH是由于阴道的专利过程,REM是非常罕见的。腹腔镜REM手术是成人诊断和治疗的一种相对普遍和有用的方法。在我们的婴儿案件中,对于这种罕见的IH患者,腹腔镜方法在调查SBO的病因和进行囊高位结扎方面同样有效.
BACKGROUND: Reduction en masse (REM) is a rare condition following manual inguinal hernia (IH) reduction in which a hernia sac is reduced back into the preperitoneal space with a loop of the bowel incarcerated at the neck of the sac. It resembles successful manual reduction and may thus be overlooked easily. We herein report an infantile
case of REM of an IH that was successfully treated laparoscopically.
METHODS: A 10-month-old boy with a surgical history of bilateral open IH repair at 4 months old presented with a bulge in his left groin and vomiting. A left incarcerated recurrent IH was suspected, and manual reduction was performed. The hernia was apparently reduced successfully, but abdominal distention and vomiting persisted. He was admitted for further observation due to the symptoms. On day 2 after admission, abdominal X-ray showed extensive small bowel obstruction (SBO). Enhanced computed tomography (CT) revealed protrusion of the small bowel with a closed-loop in the left groin. A closed-loop SBO due to postoperative adhesion or an internal hernia was suspected. To assess the etiology of SBO, emergent laparoscopic exploration with hernia repair was planned. Laparoscopy revealed REM of the left incarcerated IH with a thickened peritoneum at the neck of the sac. Laparoscopic reduction was performed, and the incarcerated small bowel showed no signs of ischemia. The hernia sac was not associated with the previously ligated processes vaginalis, which had been closed by a previous Potts\' procedure. It was located at the inside of the processes vaginalis. The sac was successfully closed by laparoscopic percutaneous extraperitoneal closure procedures, and iliopubic tract repair was also performed via the previous inguinal incision. The postoperative course was uneventful.
CONCLUSIONS: Pediatric IH is due to the patent processes vaginalis, and REM is extremely rare. Laparoscopic surgery for REM is a relatively common and useful approach for the diagnosis and treatment of adults. In our infantile
case, the laparoscopic approach was similarly effective for both investigating the cause of SBO and performing high ligation of the sac for this rare condition with IH.