ABSTRACT
An 86-year-old woman visited our hospital at 20:00 with the chief complaint of right hip joint pain that had started at around 19:30. The abdomen was soft and slightly bloated, and there was tenderness in the right hip joint. Computed tomography (CT) revealed protrusion of the small intestine through the right obturator foramen, and right-sided impacted obturator hernia was diagnosed. Intestinal necrosis was unlikely because her symptoms had started only a short time earlier, so manual reduction was performed. The right hip joint pain was rapidly alleviated, and CT confirmed release of the incarcerated bowel. Elective laparoscopic repair was then performed. Hemorrhagic ascites in the abdominal cavity, but no obvious intestinal ischemia, was evident. Intestinal dilation was relieved, enabling us to perform surgical maneuvers in a good surgical field. The postoperative course was favorable, and there has been no recurrence as of 2 years 11 months after surgery. Obturator hernia is common in elderly women, who often have several comorbidities. Avoidance of emergency surgery by manual reduction is therefore significant, and laparoscopic surgery that enables assessment and treatment of the contralateral side is beneficial.
ABSTRACT
The patient was a 73-year-old man. He had sustained a spinal cord injury in a work-related accident at 40 years of age and was living with lower body paralysis. He had defecation disorder due to poor intestinal peristalsis of the sigmoid colon. Colostomy was indicated because the defecation disorder had worsened to the extent that hospital management was required. We selected a laparoscopic approach for two reasons. First, at the time of the accident, he had undergone thoracotomy and laparotomy to treat diaphragm injury and we expected that adhesions would need to be removed in the abdominal cavity. Second, patients with spinal cord injury are prone to poor bowel peristalsis, and minimally invasive surgery should be used to prevent postoperative paralytic ileus. The operation was performed with three ports. Adhesions of the transverse colon, omentum, and abdominal wall were peeled off, the transverse colon was mobilized, and a transverse colostomy was created in the upper right abdomen. The postoperative course was favorable, and he resumed eating on postoperative day 2. Laparoscopic colostomy for patients with spinal cord injury and defecation disorder can be a safe and effective technique for improving quality of life.
ABSTRACT
Patient 1 was a 73-year-old woman with chief complaints of abdominal pain and prolapse of bowel through the anus. About 10 cm of the intestine had prolapsed through the anus, and a mass was observed at the invasive front. Computed tomography (CT) revealed the classic target sign of an intussusceptum inside an intussuscipiens, where the sigmoid colon had intussuscepted into the rectum. Patient 2 was a 92-year-old woman who presented with a chief complaint of melena. About 5 cm of the intestine had prolapsed through the anus, and a mass was observed at the invasive front. CT showed the classic target sign in the rectum. Based on physical examination and CT findings, both cases were diagnosed as intussusception caused by progression of colorectal cancer. Manipulative reduction was attempted before surgery, but neither intussusception could be reduced and thus Hartmann’s operation was performed for both patients. Patient 1 had an uneventful postoperative course and was discharged on hospital day 36. Patient 2 developed prolonged paralytic ileus due to unsuccessful mobilization and was discharged on hospital day 80. Abdominoperineal resection is required for irreducible prolapse of intussusception through the anus due to colorectal cancer, and this invasive procedure can cause complications. Many patients with this condition are elderly adults with weak pelvic supporting tissue, and thus treatment suited to each individual patient must be selected.