【读点】腹膜透析导管拔除部位的Richter疝

Richter's herniaat a Tenckhoff catheter exit site.

Authors：Martins PN, Butt K, El-Sabrout R.

Journal：Surg Laparosc Endosc Percutan Tech. 2010.Jun; 20(3):136-8.

60岁老年男性在肾移植术后3个月，出现恶心、呕吐和腹部疼痛2天的症状。临床体查和腹部X线检查不提示小肠梗阻。腹部CT扫描提示在2个月前，拔除腹膜透析导管的部位有小肠袢嵌入。最终在腹腔镜下放置生物补片进行修补。查阅文献资料，发现鲜有报道在腹膜透析导管拔除部位发生Richter疝，引发小肠梗阻的文献。Richter疝的临床表现常非常隐匿，诊断时具有迷惑性，尤其移植术后的病人，常会被免疫抑制的症状和炎症反应的体征所遮掩蒙蔽，难以明确诊断。应引起重视。

Abstract

A 60-year-old male presented with a 2-day history of nausea, vomiting, and abdominal pain 3 months after kidney transplantation. No clinical and x-ray signs of small obstruction were present. A CT scan of the abdomen showed incarcerated small bowel loop at the site of the earlier peritoneal dialysis catheter (Tenckhoff) that was removed 2 months before. The hernia was repaired by laparoscopic approach using a biologic mesh. Only a few cases of small bowel obstruction at the Tenckhoff catheter exit site have been reported in the literature but none, to our knowledge, has described a case of partial small obstruction (Richter's hernia). The presentation of Richter's hernia can be very deceiving, especially in transplanted patients because of the masking effects of immunosuppression on symptoms and signs of inflammation and difficult differential diagnosis in these patients.