肇因於閉孔疝氣的腸阻塞：一病例報告

閉孔疝氣是疝氣的一種罕見形式，也是導致腸阻塞的少見原因之一，它常發生於年老瘦弱的經產婦女，由於沒有特殊的病徵與症狀表現，術前診斷相當困難。Howship-Romberg sign和腸道阻塞是閉孔疝氣最常見的兩種臨床表徵，但是在早期Howship-Romberg sign出現時，常被以為是老年人常見的退化性骨關節炎的症狀，直到造成腸道阻塞後，藉由腹部電腦斷層攝影檢查或手術中才得以確定診斷，因此常延誤病情。因大多為年老患者，易有較高的罹病率及死亡率。我們報告一位83歲瘦弱的女性病患，住院時主訴下背痛延伸至右髖部及大腿內側疼痛、噁心、嘔吐和腹部脹痛已三天，經腹部X光檢查，發現小腸擴張併有水液平面，因懷疑有小腸阻塞，安排腹部電腦斷層攝影檢查，確診為右側閉孔疝氣併小腸嵌頓及阻塞，而接受局部腸道切除併腸吻合手術治療，術後復原良好，於一週後順利出院。

關鍵字

閉孔疝氣；腸阻塞

並列摘要

Obsturator hernia is a rare type of hernia and uncommon cause of small intestinal obstructions. Most cases are found in older, emaciated, multiparous women. Preoperative diagnosis is difficult because of the lack of external or characteristic signs. Often, there is a delay in diagnosis and surgical intervention directly contribute to high morbidity and mortality rates. The two most common presentations are intestinal obstruction and Howship-Romberg sign. Because osteoarthritis is common in elderly patients, the early Howship-Romberg sign is often misinterpreted. Emergency CT scan is useful for the diagnosis of obturator hernia, particularly in elderly patients presenting with intestinal obstruction. In most patients with obturator hernia, emergent operation is necessary for treatment of intestinal obstruction. An 83-year-old emaciated, multiparous female presented low back pain radiating to right hip and thigh area, and had nausea, vomiting, abdominal pain and fullness for 3 days. Plain abdominal radiography showed multiple dilated intestinal loops with air-fluid level indicating a small bowel obstruction. Abdominal computed tomography revealed an incarcerated right obturator hernia. Emergent laparotomy with resection of the gangrenous part of small bowel with end-to-end anastomosis was performed. The postoperative course was smooth. (J Intern Med Taiwan 2012; 23: 124-129)

並列關鍵字

Obturator hernia ； Intestinal obstruction

國際替代計量

肇因於閉孔疝氣的腸阻塞：一病例報告

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