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Das „verlorene Heimatrecht“ – eine chirurgische Herausforderung

Operative Versorgung einer monströsen Skrotalhernie

Loss of domain—a surgeon’s challenge

Surgical approach to an enormous scrotal hernia

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Zusammenfassung

Wir berichten über das einzeitige Vorgehen bei der operativen Versorgung einer monströsen Skrotalhernie. Der Bruchsack enthält das gesamte Dünndarmkonvolut und Anteile des Dickdarmes; es besteht für den Bruchsackinhalt die Situation eines „verlorenen Heimatrechtes“. Unter Verwendung einer Mesh-augmentierten Komponentenseparation der Bauchdeckenmuskulatur nach Ramirez gelingt es, den gesamten Bruchinhalt in die Bauchhöhle zu replatzieren und ein konsekutives abdominelles Kompartmentsyndrom zu verhindern. Wir stellen unser operatives Vorgehen detailliert dar und berichten über das intensivmedizinisch getragene Komplikationsmanagement, welches nach prolongiertem Verlauf zur Entlassung am 57. postoperativen Tag führt.

Abstract

We report on the one-stage procedure surgical approach to an enormous scrotal hernia bearing the whole small bowel and part of the large bowel as a loss of domain situation. Using a mesh-based component separation abdominal wall technique according to Ramirez we managed to retrieve the hernia content into the abdominal cavity allowing reduction of the resulting intra-abdominal pressure. We present our surgical approach in detail and report on the postoperative process based on focused intensive care surveillance and specific surgical complication management leading to hospital discharge of the patient on postoperative day 57.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Philipp, S. Förster und E. Klar geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Abteilung für Allgemeine, Thorax-, Gefäß- und Transplantationschirurgie, Chirurgische Universitätsklinik Rostock, Schillingallee 35, 18057, Rostock, Deutschland

    M. Philipp, S. Förster & E. Klar

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  1. M. Philipp
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  2. S. Förster
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  3. E. Klar
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Correspondence to M. Philipp.

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Die Vorstellung des Falles erfolgte auf der 189. Tagung der Vereinigung Nordwestdeutscher Chirurgen im Juni 2012 (Preisträger) und 2013 als Poster auf dem Chirurgenkongress in München.

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Philipp, M., Förster, S. & Klar, E. Das „verlorene Heimatrecht“ – eine chirurgische Herausforderung. Chirurg 85, 1005–1009 (2014). https://doi.org/10.1007/s00104-014-2789-8

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  • DOI: https://doi.org/10.1007/s00104-014-2789-8

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