精索ブロックと精索静脈瘤手術が有効であった鼠径ヘルニア術後の慢性疼痛

Nerve block and varicocelectomy of the spermatic cord are effective for treating pain after inguinal hernia repair : A case report

　57歳男性．右鼠径ヘルニア根治術を施行後，慢性的な右鼠径部痛を発症．勃起時痛・射精時痛も伴い泌尿器科を紹介された．精索ブロックが著効し，また精索静脈瘤を認めたため，右精索静脈瘤低位結紮術を施行．術後疼痛は改善した．鼠径ヘルニア根治術後の慢性疼痛は近年問題視されており，メッシュによる精索の神経への炎症の波及が原因とされている．精索の神経に対する理解が重要であり，泌尿器科的な介入が有効な場合もある．

Abstract

A 57-year old man had been complaining of chronic groin pain since right inguinal hernia repair. Since he also had erectile and ejaculatory pain, he was recommended to receive urologist's consultation. A nerve block of the spermatic cord was successful. Since he also had a varicocele, he underwent a subinguinal varicocelectomy. His pain improved after the operation. Recent reports show how chronic groin pain after hernia repair is a problematic complication. The cause seems to be invasion of the spermatic cord's nerves by inflammatory tissue surrounding the mesh. It is important in such cases to understand the anatomical relationships of the nerves of the spermatic cord and appreciate that urological interventions are needed (Rinsho Hinyokika 71 : 1019-1023, 2017).