二期的に腹腔鏡手術で治療した穿孔性虫垂炎を伴う再発性Amyand's herniaの1例

A case of recurrent Amyand's hernia with perforated appendicitis successfully treated by staged laparoscopic surgery

◆要旨：症例は79歳，男性．両側内鼠径ヘルニアに対し，プラグ法にてヘルニア修復術を施行された4年後に，右鼠径部痛を主訴に来院した．CT検査にて，炎症を伴う虫垂が鼠径管からヘルニア囊へ脱出している所見を認め，穿孔性虫垂炎を伴うAmyand's herniaと診断し臨時手術を施行した．腹腔鏡下虫垂切除術を行い，その際に左再発内鼠径ヘルニアも認めた．3か月後に，メッシュを用いた両側腹腔鏡下ヘルニア修復術を行った．虫垂炎を伴うAmyand's herniaが再発鼠径ヘルニアに生じることは稀であるが，本症例のように，腹腔鏡下に二期的手術を行うことで，腹膜炎の状態や対側鼠径部の状況も把握し，最終的にメッシュを用いた根治的手術が可能であり，有用性が示唆される治療方法であると考えられた．

　We present our experience with a 79-year-old man who underwent hernia repair using the Mesh-Plug procedure for bilateral direct inguinal hernias four years ago. He visited our hospital complaining of right groin pain. Computed tomography revealed that the inflammatory appendix prolapsed through the inguinal canal into a recurrent hernia sac. We diagnosed it as irreducible hernia including gangrenous appendicitis. Laparoscopic appendectomy in urgent surgery was performed, during which a recurrent left inguinal hernia was also found intraoperatively. Bilateral laparoscopic hernia repair using mesh was performed three months after the initial surgery. It is rare for appendicitis to occur in an Amyand's hernia which was recurred. However, as in the present case, a two-step laparoscopic operation enables us to grasp the state of the peritonitis and the condition of the contralateral groin and finally perform repair surgery for recurrent bilateral inguinal hernia using mesh. Therefore, this two-step treatment strategy is helpful for Amyand's hernia with appendicitis.