大腿骨頚部骨折を疑った閉鎖孔ヘルニアの1例

Obturator Hernia, Minicking a Hip Fracture. Case Report

　82歳の女性で，自室でつまずいて右股関節部の激痛を訴えて来診した．股関節部には骨折の所見はなかった．腹痛，吐き気を訴え，骨盤CT像で恥骨閉鎖孔部に円形の軟部腫瘤陰影があった．閉鎖孔ヘルニア嵌頓の診断で，緊急開腹手術を施行した．閉鎖孔ヘルニアの嵌頓では股関節部から大腿内側にかけて激痛を訴え，高齢の女性では脊椎，股関節の疾患，大腿骨頚部骨折による疼痛と誤診される危険がある．嵌頓した腸管が壊死，穿孔すると腹膜炎，播種性血管内凝固，多臓器機能不全となり，死亡率は18～30％である．閉鎖孔ヘルニアの骨盤CT像は特徴のある所見で，股関節部痛に腹痛，吐き気を訴える症例では，骨盤恥骨下端までのCT撮影が診断に有用である．

　An 82-year-old woman stumbled in her room and then complained of the severe pain in her right hip.　She also complained of nausea and pain in her stomach.　CT of the pelvis revealed a round, homogenously dense mass between the pubis and the external obturator muscle.　A preoperative diagnosis of obturator hernia was made, and emergency laparatomy was performed.　The hernia mass had stimulated the obturator nerve and caused the patient to complain of severe pain from her hip to her thigh, i.e, the Howship-Romberg sign.　This sign is often confused with the pain originating in the spine, hip joints, and fractures of the femoral neck in elderly patients.　Delays in making the correct diagnosis and providing appropriate treatment can result in the patient's death.　CT scanning of the pelvis is useful for making the diagnosis of obturator hernia.　CT of the pelvis should be performed in patients who complain of pain around the hip and have manifestations of ileus.