二期的に腹腔鏡下手術と鼠径部切開法で治療したAmyand's herniaの1例

A case of Amyand's hernia treated with a two-stage laparoscopic approach and anterior inguinal hernia repair

◆要旨：症例は62歳，男性．右鼠径部の膨隆を主訴に前医を受診し，鼠径ヘルニア嵌頓の診断で徒手整復が試みられたが還納困難であり，当院を紹介され受診した．CT所見を踏まえ鼠径ヘルニア虫垂嵌頓と診断したが腹部症状はなく，血液検査で炎症反応は乏しく，画像検査で腸閉塞所見はなかったため待機的に手術を施行した．初回手術では腹腔鏡と鼠径部切開の併用で虫垂切除およびメッシュ感染のリスクを低減すべく高位結紮のみでヘルニア修復を行った．術後20日間の間隔を空けて2回目の手術で腹腔鏡下にメッシュを用いてヘルニアを修復した．鼠径ヘルニア虫垂嵌頓に対して待機的かつ二期的手術で治療を行った報告はなく，文献的考察を加えて報告する．

　A very rare case of inguinal hernia with an incarcerated appendix（Amyand's hernia） treated by elective two-stage surgery with a laparoscopic approach and anterior inguinal hernia repair is reported. A 62-year-old man was admitted to a local clinic with a chief complaint of a right inguinal bulge. He was diagnosed with an incarcerated inguinal hernia, and manual reduction was attempted; however, he was referred to our hospital because the manual reduction was unsuccessful. On the basis of the CT findings, the patient was diagnosed with Amyand's hernia without any signs of intestinal obstruction. He had no abdominal symptoms, and blood tests showed little inflammatory reaction; therefore, we planned an elective two-stage operation. In the first operation, we performed appendectomy using a combination of laparoscopic and anterior approaches and performed hernioplasty with only high ligation to reduce the risk of surgical site infection using mesh. Twenty days after the first surgery, we performed hernioplasty using mesh laparoscopically, and the patient was discharged 2 days after surgery with an uneventful clinical course and no sign of recurrence. The present case is reported with a literature review.