用手整復後に左閉鎖孔ヘルニア偽還納と診断し腹腔鏡下に修復した1例

A case of reduction en masse of a left obturator hernia preoperatively diagnosed and treated by laparoscopic surgery

◆要旨：症例は75歳，男性．腹部膨満感を主訴に当院を受診した．単純CTで左閉鎖孔ヘルニアと診断し，超音波下に用手整復を施行した．超音波検査で脱出した小腸は消失し，単純CTでも小腸は閉鎖孔から整復されていた．経過観察入院としたが，腸閉塞症状の改善がみられなかった．第3病日に造影CTを施行し，左閉鎖孔ヘルニアの偽還納と診断し，腹腔鏡下に手術を施行した．左閉鎖孔からヘルニア囊は還納されていたが，腹膜前腔で腹膜をヘルニア門として小腸が嵌頓していた．ヘルニア囊を切開し，小腸の嵌頓を解除した．嵌頓小腸は軽度の発赤のみで腸切除は要さなかった．閉鎖孔ヘルニアの偽還納は現在までに報告例がなく，稀な症例を経験したため，報告する．

　A 75-year-old man developed abdominal distension and visited our hospital. An abdominal CT scan showed a left obturator hernia and manual reduction using ultrasonography was performed. CT scan after manual reduction showed that the small intestine had been reduced from the obturator foramen ; the patient was admitted to the hospital for observation. However, there was no improvement in ileus symptoms for several days. On the 3rd day after admission, a contrast-enhanced CT scan was performed, and we diagnosed reduction en masse of the left obturator hernia. The operation was performed laparoscopically. Although the hernia sac was reduced through the obturator foramen, the small intestine was incarcerated in the hernia sac at preperitoneal space. The hernia sac was incised and the incarceration of the small intestine was released. The incarcerated small intestinal wall showed only mild redness and therefore the intestinal resection was not performed. Reduction en masse of hernia is extremely rare and there has been no report of reduction en masse of obturator hernia in the past. We report a case of reduction en masse of left obturator hernia.