A CASE OF ACUTE APPENDICITIS IN AN INGUINAL HERNIA
A CASE OF ACUTE APPENDICITIS IN AN INGUINAL HERNIA
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腹股沟疝气急性阑尾炎一例
DOI：
10.3919/jjsa.60.2423
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
M. Umeki
中科院分区：
文献类型：
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作者：
E. Kihana;S. Kurisu;T. Hatta;T. Koyama;Y. Kita;M. Umeki
据报道，嵌顿性腹股沟疝气伴有阑尾炎穿孔伴化脓性腹膜炎。一名 69 岁男性因腹股沟右侧出现疼痛性肿块就诊，但与恶心和呕吐无关。白细胞计数和C反应蛋白中度升高。腹部X光片显示小肠轻度扩张，但无梗阻迹象。腹股沟隆起上方的腹部超声检查显示液体潴留和从右侧腹股沟内环突出的阑尾样结构。诊断为右侧嵌顿性腹股沟疝，并进行了紧急手术。疝囊因炎症而紧张且增厚。打开囊，露出附着在囊上的发炎阑尾。通过腹股沟疝一期修复术扩大腹股沟内环后，可以轻松进行阑尾切除术。该患者术后病程平稳。这种情况非常罕见，我们临床医生术前做出准确诊断有很大困难。然而，目前腹股沟疝压痛且无肠梗阻症状以及腹股沟隆起上方腹部超声检查应有助于术前准确诊断。
A case of incarcerated inguinal hernia in which a perforated appendicitis with purulent peritonitis is reported. A 69-year-old man presented with a painful mass in the right side of groin, which was not associated with nausea and vomiting. White blood cell count and C-reactive protein were moderately elevated. Abdominal X-ray films showed mild distention of the small intestine but no evidence of obstruction. Abdominal ultrasonography above the inguinal bulge showed fluid retention and an appendix-like structure protruding from the right internal inguinal ring. A diagnosis of right incarcerated inguinal hernia was made and an emergency operation was performed. The hernia sac was tense and thickened with inflammation. The sac was opened to reveal an inflamed appendix adhered to the sac. An appendectomy was performed easily after enlarging the internal inguinal ring with a primary repair of the inguinal hernia. The patient had an uneventful postoperative course. This condition is so rare that we clinicians find a great deal of difficulty in making accurate diag-nosis preoperatively. However, present illness of tender inguinal hernia without ileus symptoms and abdominal ultrasonography above the inguinal bulge should be helpful for the accurate preoperative diagnosis.