月経随伴性気胸に対する横隔膜部分切除後の横隔膜ヘルニア嵌頓に対し腹腔鏡下手術で修復し得た1例

A case of post operative diaphragmatic hernia after a catamenial pneumothorax repair treated successfully by laparoscopic surgery

◆要旨：患者は22歳，女性．上腹部痛にて前医で上部内視鏡検査を施行した．胸部単純X線所見と併せ，左横隔膜ヘルニア，胃嵌頓の疑いで当院に紹介され受診となった．2年前に左月経随伴性気胸に対して胸腔鏡下手術を施行し，横隔膜を自動縫合器で部分切除されていた．当院でのCT検査でステイプラー近傍の横隔膜から胃穹窿部が脱出した所見を確認し，緊急手術を施行した．腹腔鏡下にヘルニア門を観察し，超音波切開凝固装置で横隔膜を切開して嵌頓を解除した．胸腔内を洗浄して胸腔ドレーンを挿入後に横隔膜を縫合・閉鎖した．横隔膜ヘルニア緊急例においても，正確な術前診断と患者の状態によっては腹腔鏡下手術も可能であると考えられた．

　We report a case of incarcerated diaphragmatic hernia repaired by laparoscopic surgery. A 22-year-old woman had upper abdominal pain. Endoscopic finding and chest X-ray showed herniation of the stomach to the left thoracic cavity. The patient had undergone partial resection of the left diaphragm due to catamenial pneumothorax two years before. Computed tomography showed herniation of the upper third of the stomach near the staplers of the automatic suture device through the left diaphragm. An emergency operation was performed by laparoscopic approach. We identified herniation of the stomach from beside the esophageal hiatus. The diaphragm was divided by laparoscopic coagulating shears. After insertion of a thoracic drainage tube, the defect of the diaphragm was repaired by direct closure. The patient has been asymptomatic for 6 months after the second operation.