腹腔鏡下肝右葉切除後に発症した横隔膜ヘルニア嵌頓に対して腹腔鏡下ヘルニア修復術を行った1例

Laparoscopic repair of incarcerated diaphragmatic hernia as a late complication after laparoscopic right hepatectomy

◆要旨：症例は89歳，男性．前医で肝細胞癌に対して腹腔鏡下肝右葉切除術が施行された．術後5年4か月に上腹部痛を主訴に救急搬送された．腹部CT検査で胸腔内に結腸の脱出を伴う右横隔膜ヘルニア嵌頓を認め，緊急手術で腹腔鏡下ヘルニア修復術を行った．背側の右横隔膜に欠損を認め，同部位より横行結腸と大網が右胸腔内に脱出し嵌頓していた．ヘルニア内容を還納すると虚血所見はなく温存可能であった．ヘルニア門は3-0 V-Loc^TMを用いて腹腔鏡下に連続縫合で閉鎖した．腹腔鏡下肝切除後の横隔膜ヘルニアは稀な合併症ではあるが，嵌頓すると重篤化する可能性があり，晩期合併症の1つとして念頭に置く必要がある．

　An 89-year-old male patient who had undergone laparoscopic right hepatectomy for hepatocellular carcinoma was admitted due to abdominal pain. An abdominal CT revealed diaphragmatic incarcerated hernia. Laparoscopic diaphragmatic hernia repair was performed as an emergency surgery. The transverse colon and greater omentum were incarcerated at the diaphragmatic hernia orifice. The incarcerated colon was repositioned into abdominal cavity, and the diaphragm was closed by continuous suture with 3-0 V-Loc^TM. An incarcerated diaphragmatic hernia may result in a serious outcome. Therefore, though rare, it should be considered as a possibility for late complication of laparoscopic hepatectomy.