CTで術前診断しえた鼠径ヘルニアによる続発性大網捻転症に対して腹腔鏡下手術が有用であった1例

Laparoscopic surgery for secondary omental torsion due to an inguinal hernia : a report of a case

症例は59歳，男性．2006年7月，右下腹部痛を主訴に近医を受診し，鼠径ヘルニア嵌頓の診断で当院に紹介となった．腹部CTにて渦巻状の高濃度領域を含む腫瘤が右側腹部からダグラス窩にかけて存在し，右鼠径ヘルニア囊内まで連続していた．右鼠径ヘルニアに続発した大網捻転症と診断し，腹腔鏡下手術を行った．大網全体が暗赤色を呈し，遠位側はヘルニア門近傍に癒着し，近位側は横行結腸付着部で捻転していた．腹腔鏡下に癒着を剝離した後，小開腹創より捻転部を挙上して切離し捻転大網を摘出した．本症は稀ではあるが，CTの特徴的な所見により術前診断が可能であった．また，腹腔鏡下手術は診断的意義があり，治療にも移行できるため有用と考えられた．

　A 59 year-old man complaining of right lower abdominal pain, was referred to our hospital from a neighboring doctor diagnosed as having an incarcerated inguinal hernia. Abdominal computed tomography（CT）showed a low density mass with a concentric strands of high intensity area in the right flank, extending to the Douglas pouch and the right inguinal hernia sac. A diagnosis of secondary omental torsion associated with a right inguinal hernia has made The patient underwent a laparoscopic surgery. Surgical findings showed that the right portion of the greater omentum was dark-red in color ; the proximal side was twisted and the distal side adhered near the inguinal hernia ring. Minilaparotomy was performed, releasing the adhesion and resecting twisted omentum. Although omental torsion is a rare entity, preoperative diagnosis was possible because of the characteristic CT findings. We concluded that laparoscopic surgery is a very effective method for making a definitive diagnosis and resecting of the twisted omentum.