每日一题_2025.07.04

A 77-year-old woman presented to the emergency department with a 2-day history of abdominal pain, nausea, and vomiting. On physical examination, there was abdominal distension with tenderness in the left lower quadrant. Computed tomography of the abdomen showed herniation of a loop of ileum on the left side inferior to the inguinal ligament, lateral to the pubic tubercle, and medial to the common femoral vessels with compression the femoral vein. Small bowel loops were dilated proximal to the herniation and collapsed distal to it. What is the most appropriate management for this patient?

一位77岁女性因腹痛、恶心、呕吐2天至急诊就诊。体格检查发现腹部膨隆，左下腹有压痛。腹部CT显示：一段回肠疝入腹股沟韧带下方、耻骨结节外侧、股总血管内侧的左侧区域，并压迫股静脉。疝入部位近端的小肠扩张，远端小肠塌陷。对该患者最恰当的处理措施是：

A. Bowel regimen肠道调节治疗

B. Elective surgical repair择期手术修补

C. Emergent surgical repair紧急手术修补

D. Manual reduction手法复位

E. Nasogastric tube insertion and nil per os鼻胃管置入并禁食

答案解析：

AI回答：患者表现为典型的股疝嵌顿​（疝囊位于腹股沟韧带下方、股血管内侧），CT证实小肠梗阻（近端扩张、远端塌陷）及股静脉受压，提示存在肠缺血风险。股疝嵌顿易迅速发展为绞窄性疝，导致肠坏死，因此需紧急手术修补​（C正确）。

正确答案是紧急手术修补。影像学检查显示患者患有嵌顿性股疝。由于股环（股管开口）直径较小，股疝比腹股沟疝更容易发生嵌顿和绞窄。因此，建议在出现并发症之前进行股疝手术修补。针对该患者，医生实施了急诊剖腹探查术并修补疝缺损。

正确答案：C