Postponing treatment for hernias can damage the small intestine 疝氣遲不就醫 小心小腸壞死

Tue, Oct 09, 2012 - Page 11

Many people suffer from hernias, but since the afflicted areas do not usually hurt, people can go a decade or longer without feeling like they need to seek medical help, sometimes waiting so long that the small intestine, in men, becomes lodged in the scrotum, causing extreme pain and possibly irremediable damage to the small intestine. Doctors say that the chance of relapse after having surgery is low and that by treating the hernia as soon as possible you can make a speedy recovery.

A man surnamed Huang, 69, discovered a protruding lump located on the lower right side of his abdomen, but put off going to the doctor because he did not experience any discomfort. Eventually, however, after going to the Buddhist Tzu Chi General Hospital the doctor discovered another small hernia on the left side of his abdomen as well. Accepting the doctor’s recommendation, Huang underwent laparoscopic surgery to treat the two hernias and made a quick recovery after the surgery.

Lee Cheng-hung, a surgeon at the Buddhist Tzu Chi General Hospital, says that hernias occur, in men, most commonly because during birth the testes migrate from the abdomen to the scrotum, but the pathway does not close up naturally, which allows the intestine inside the abdomen to fall into the scrotum. Due to the increasing frailness of the lining of the abdomen with age and its loss of elasticity, a hard enough cough or excessive physical exertion can cause the intestine to fall down into the scrotum.

Lee says that with a minor hernia, the patient will typically feel like there is a ball-like structure protruding from their lower abdomen and some slight pressure in the area, but will not usually feel any pain. Since there is not any pain, many people put off going to the doctor until the small intestine gets stuck in the scrotum, which can cause damage to the small intestine, peritonitis, or even sepsis, he says.

Lee also says that besides traditional surgery, patients can choose to undergo laparoscopic transabdominal preperitoneal hernia repair (TAPP), which leaves smaller incisions, heals more quickly, and causes less pain. He says that for patients like Huang, who have hernias on both sides of the abdomen, they must have two separate surgical incisions made, leaving bigger scars and causing more pain, but says that with laparoscopic surgery three small incisions can be made to treat both hernias.

Laparoscopic surgery requires full-body anesthesia, which is not suitable for everyone. With traditional surgery, anesthesia is used on half the body and the incision made is usually only 5cm to 7cm. People with hernias are urged to seek medical treatment as soon as possible.

(Liberty Times, Translated by Kyle Jeffcoat)

許多人有疝氣問題,但因患部不會痛,患者常一拖十幾年,等到小腸卡在陰囊內後會引發劇烈疼痛,甚至可能造成小腸壞死。醫師表示,其實疝氣患者開刀治療後復發率極低,及早治療可恢復健康。

六十九歲的黃姓患者去年發現右下腹部有鼓脹的現象,因為沒有任何不適症狀,遲遲未就醫治療。後來到大林慈濟醫院檢查時,發現右側疝氣外,左側也有輕微疝氣,接受醫師建議,以腹腔鏡手術同時處理雙側疝氣,術後順利恢復健康。

大林慈濟醫院一般外科醫師李政鴻說,疝氣是因出生時,睪丸自腹部降至陰囊的通道未自然閉合,導致腹腔內的腸子循著通道掉入陰囊內;另外則是腹腔壁的脆弱處因老化而喪失彈性,只要一咳嗽、用力,腸子就會跑到陰囊內。

李政鴻說,輕度的疝氣患者會覺得下腹部突出「一丸」,只會覺得悶悶的,不會感覺疼痛。由於患部不會痛,許多病患延誤治療,等到小腸卡在陰囊內可能造成小腸壞死、腹膜炎,甚至引發敗血症。

李政鴻說,疝氣治療除傳統手術外,也可採取傷口較小的腹腔鏡疝氣修補手術,復原速度快,疼痛也輕。他說,像黃姓男子有雙側疝氣的患者使用傳統手術需要兩邊動刀,傷口大、較疼痛,採腹腔鏡手術,可利用三個小傷口同時處理雙側疝氣。

腹腔鏡手術需全身麻醉,並非人人適合。即使採傳統手術治療,只需半身麻醉,傷口也僅五到七公分,呼籲疝氣患者勿拖延,及早治療。

(自由時報記者林宜樟)