本文报道1例先天性文氏孔疝伴嵌顿的罕见病例，分享其诊断思路、治疗经验，总结其发病因素、手术方案、个性化治疗和相关文献复习。

青年男性，既往无手术、外伤史，否认慢性腹痛、便秘等病史。腹痛伴便血5小时，腹部CT示胃腔扩张胀气，十二指肠区形态欠规整伴局部管腔扩张、气液平，考虑十二指肠憩室、肠扭转可能，梗阻不除外。患者入院后保守治疗后出现腹痛进行性加重，急诊在全麻下行腹腔镜探查术，术中证实回肠文氏孔疝伴嵌顿，腹水约200 ml，疝环扩张直径约3 cm，疝入回肠长约50 cm。遂行腹腔镜下扩张肠管减压、疝内容物还纳、文氏孔止血纱＋医用胶封堵术。

术后恢复顺利，腹痛缓解，排气排便正常，复查CT肠管无扩张，随访6个月无复发迹象，目前仍密切随访。

该病例展示了文氏孔疝的诊断与治疗过程，强调了术前影像诊断检查、及时手术决策对于正确诊断和治疗效果的重要性。文氏孔疝属于较罕见腹内疝，缺乏特异性临床表现，极易引起疝内容物嵌顿，早期容易与肠梗阻混淆，病情进展快，误诊容易引起肠坏死、肠穿孔、脓毒血症等危及生命，因此在临床中应高度重视影像学检查的特异性、腹部体征的变化。尽早微创手术探查既是检查方式，也是预防肠坏死的主要治疗方式，而个体化的文氏孔修补方式对于预防复发至关重要。

We report a rare case of congenital, incarcerated HFW, discussing its diagnosis, management, and surgical strategies along with a literature review.

Case Description A young male with an unremarkable medical history presented with abdominal pain and hematochezia for 5 hours. Abdominal CT showed gastric dilatation, irregular duodenal contour with localized luminal expansion, and air-fluid levels, initially suspicious for a duodenal diverticulum or volvulus with possible obstruction. Treatment Due to progressive pain despite conservative therapy, emergency laparoscopy was performed, revealing an incarcerated ileal HFW with 200 ml ascites, a foramen diameter of 3cm, and herniated ileal segment of 50 cm. Laparoscopic bowel decompression, hernia reduction, and foramen closure with hemostatic gauzeplus medical gluer were successfully executed.

The patient recovered uneventfully with normal bowel function. Follow-up CT was clear, and no recurrence was observed at 6 months.

HFW mimics simple bowel obstruction but progresses rapidly to necrosis, perforation, or sepsis if misdiagnosed. High vigilance regarding specific CT findings and changing abdominal signs is crucial. Early laparoscopic exploration is both diagnostic and therapeutic to prevent necrosis, while individualized foramen closure is key to preventing recurrence.