罕見術後會陰疝氣一病例報告

A Rare Case of Postoperative Perineal Hernia

會陰疝氣是一種臨床上罕見疝氣的疾病，最常發生於老年婦女。行腹部會陰切除手術併發會陰疝氣在歷史上意義是稀少的。臨床症狀表現為會陰處感覺突出下垂、不舒適，皮膚破損、尿道症狀及腸阻塞等症狀。其盛行率0.13%-0.9%。我們報告臨床一會陰疝氣的案例，此個案58歲女性婦女，因3年前在他院直結腸癌手術行腹部會陰切除手術（abdominol-perineal resection, APR），左側腹部有人工肛門造口，於門診追蹤。她因近期感覺肛門有一個凸起狀態及下墜感，引起疼痛不適來本院求診。經由臨床顯現是腹部會陰手術併發會陰疝氣。我們體驗與討論，認為充份熟悉腹部會陰切除手術併發會陰疝氣的病程再加超音波診斷疝氣內容物或由X光配合顯影、電腦斷層掃瞄攝影確定診斷以縮短病發至手術時間，有助於降低因疝氣引起的腸壞死、併發症、危險性。

Perineal hernia is a rare disease and most commonly seen in the elderly female patients. Usually it is the complications of Abdomino-Perineal Resection (APR) and the incidence is about 0.13-0.9%.We present a 58 year old lady who underwent APR for rectal cancer at other hospital 3 years before admission to our hospital .She felt a protrusion mass gradually increang in size at the previous perineal wound. She also sustained a dragging sensation with dull aching pain in the perineum. We fend a soft fist size protrusion mass as the perineal area and bulging tense with Valsalver maneuver. The mass disappeared on lying down and a big fascia defect was palpable under the skin of the perineal wound. Abdominal CT was arranged to rule out the recurrence of rectal cancer before operation and finding support our clinical impression. We perform an exploration of the hernia and find a wide gap of pelvic floor in the perineum. So after closure of the thick fibrotic hernia sac, prolene mesh was used for repair. The postoperative course was uneventful and no recurrence was seen until recent follow up after 11/2 year of operation.