A huge transverse double cavity stoma irreducible hernia: a case

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A female patient, 65 years old, ten years ago of rectal carcinoma after anterior resection of anastomotic fistula and underwent transverse d

Content

A female patient, 65 years old, ten years ago of rectal carcinoma after anterior resection of anastomotic fistula and underwent transverse double cavity fistula. After five years to appear around the stoma parastomal hernia, and increased gradually, is also satisfied, Transversostomy proximal colonic mucosa prolapse at. CT showed abdominal hernia neck width is about 7cm, the hernia sac diameter 13cm, the hernia contents of intestine and omentum.

Disease analysis:

1 patients with rectal cancer surgery, anal fistula and distal disuse for ten years, can not determine the anus and colon with intestinal and bowel function, secondly, the patients had anastomotic fistula, intra-abdominal adhesion is serious, especially in the left lower abdomen bowel free will cause serious bowel injury. Therefore, it is not feasible to use a new approach for the resection of the fistula and the repair of the colostomy or sigmoid colostomy after repair of the hernia;

2, if the terminal ileum stoma and parastomal hernia repair, the patient will cause the entire colon unprovoked disuse, excessive damage to the patients, the surgery for patients with The loss outweighs the gain.

3, the operation plan is: "laparoscopy + intraperitoneal adhesions + original fistula resection and in situ re transverse double cavity fistula + parastomal hernia repair"; so as to achieve the purpose of parastomal hernia repair, but also to avoid the unnecessary loss in patients with excessive colon.

Intraoperative findings:

1, laparoscopic exploration found that severe intra-abdominal adhesions, gradually sharp separation and abdominal adhesions in the abdominal wall of the bowel, upstream from a sufficiently large area of mesh placement;

2, the hernia contents of intestine and omentum plugging in the hernia sac, can not accept, then the use of laparoscopic gradually severed adhesions and also the hernia contents;

In 3, resection of the primary fistula and free stoma fistula distal ends, found that due to the waste caused by the transverse severe stenosis of the lumen, a diameter of about 0.5cm, it is of no use value, consistent with the preoperative analysis;

In 4, resection of hernia sac, off hernia sac, the transverse colon fistula after resection of sigmoid stump fistula in re abdominal wall stoma (formation of shotgun like structure), a subcutaneous negative pressure drainage;

5, the keyhole patch was used to fix the abdominal wall.

Expert tips:

No matter what kind of adult hernia, no healing may, with the passage of time can only be more and more big, the operation will be more and more complex. For doctors, the operation is more difficult; for patients, the risk of surgery increased, the probability of occurrence of surgical complications on the large, must be early surgery to minimize the risk.

 

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