2025年 · 第40卷第05期

The importance of general surgery in surgery and even the whole human medicine lies in the fact that general surgical diseases (including trauma) are the most common surgical diseases, and their scope includes important organs of the human body, such as thyroid, breast, liver, pancreas, spleen, gastrointestinal tract, etc.; Secondly, the pathophysiology of these important organ diseases involves many basic surgical problems, and their surgery includes a large number of basic surgical operations; Third, general surgery is an indispensable and important stage in the growth of surgical specialists. Every surgical specialist should go through three or four years of general surgery training. The above three points have fully demonstrated that general surgery is the basis of surgery.

A 78-year-old male was admitted for "abdominal pain and distension with cessation of exhaustion and defecation for 2 d". It was accompanied by nausea and vomiting, which continued to worsen without relief. Emergency abdominal CT showed small bowel obstruction, right inguinal hernia (Figure 1). No history of hypertension, diabetes, coronary heart disease, etc. No history of drug or food allergies. The right inguinal hernia was repaired more than 50 years ago, and the left inguinal hernia was repaired by preperitoneal patch under local anesthesia more than 20 years ago. The patient self-complained that the symptoms of intestinal obstruction appeared periodically for more than 10 years, with the interval of attack cycles ranging from 2 to 4 months, and had been hospitalized for conservative treatment many times. After admission, the patient was given symptomatic treatment such as fasting, gastrointestinal decompression and total parenteral nutrition. The patient's symptoms were relieved, and defecation and exhaust were resumed. Abdominal enhanced CT showed small intestinal obstruction, right inguinal hernia, suspected calcification, local adhesion and thickening in the left lower abdominal wall (Figure 2). Laboratory test: white blood cells 5.4×10⁹/L, C-reactive protein 128.0 mg/L. Laparoscopic exploration showed that the adhesion in the left inguinal hernia repair area was thickened, the preperitoneal patch was curled into a mass, and some of the patch adhered to the small intestine. The patch eroded and fused in the small intestine wall (Figure 3), and the patch fused with the small intestine wall, which was difficult to peel off. The patch was cut at the patch-small intestine junction, and partial small intestine resection and small intestine-small intestine anastomosis were performed. The residual patch in the left inguinal area was densely adhered to the vascular nerve tissue and could not be separated. The peritoneum was tightly sutured to isolate the patch. Postoperative pathology: Chronic inflammation of small intestinal mucosa, foreign body granulomatous inflammation of intestinal wall and periintestinal adipose tissue. The patient recovered well after surgery and had unobstructed stool. After reexamination of abdominal CT, the calcified nodules disappeared (Figure 4). The postoperative outpatient follow-up for 8 months showed no recurrence of intestinal obstruction and no recurrence of left inguinal hernia.