De Garengeot hernia内虫垂に発生した低異型度虫垂粘液性腫瘍に対して腹腔鏡下と前方到達法の併用手術を施行した1例

Low-grade appendiceal mucinous neoplasm within De Garengeot hernia : A case report

◆要旨：虫垂をヘルニア内容とする大腿ヘルニアはDe Garengeot hernia（DGH）と呼ばれ，稀な疾患である．症例は84歳，女性．CTでDGHを認めたが，明らかな炎症や悪性所見を認めなかったため，待機的手術を施行した．腹腔内からの嵌頓解除は困難であったため，前方到達法により虫垂を可及的根部で切離した．腹腔鏡下で大腿ヘルニア根治術を施行し，虫垂根部を再度切離した．病理組織検査は低異型度虫垂粘液性腫瘍（LAMN）の診断であった．再切離断端は陰性であったが，暫定的切離断端は陽性であった．DGHに生じたLAMNの症例は本邦での報告はなく，本症例の反省を踏まえて，至適治療方針を考察する．

　De Garengeot hernia（DGH） is a rare form of femoral hernia that contains the appendix. An 84-year-old woman presented to our hospital with a one-day history of abdominal pain. An abdominal CT scanning showed DGH with neither inflammatory nor malignant findings. Laparoscopic elective surgery was performed but converted to open approach, as the incarceration of appendix was observed. The appendix was initially resected by open method, then hernia repair and total resection of the remnant appendix were performed laparoscopically. Histopathological specimen revealed low-grade appendiceal mucinous neoplasm（LAMN）. Although the re-excision margin of the base of the appendix was negative, the margin of primary excision was positive for malignancy. The postoperative course was uneventful with no sign of recurrence during the follow-up period. We herein report this rare case of LAMN within a DGH with review of the surgical approach in the present case and analysis for optimal strategy.