腹腔鏡下手術にて診断・治療し得た子宮広間膜裂孔ヘルニアの1症例

Internal hernia of the broad ligament of the uterus diagnosed and treated by laparoscopic surgery

◆要旨：患者は50歳代，女性．2005年5月下旬，腹部膨満，嘔吐を繰り返すため，当院を受診した．腹部X線，CTにてイレウスと診断し，緊急入院となった．入院当日にイレウス管を挿入し，挿入第3日目に腹部症状が軽快したためにイレウスの原因の検索と治療目的に腹腔鏡下手術を施行した．腹腔内を観察すると，左子宮広間膜の異常裂孔に小腸が約30cm嵌入していることが確認されたためにこれを解除し，裂孔は体内結紮にて閉鎖した．嵌入していた小腸に壊死像はなかった．術後経過は良好で，患者は，術後第11病日目に退院した．術前診断が難しい稀な本疾患に対して，腹腔鏡下手術は診断と治療を兼ね備えた有用な術式であることが示唆された．

　A 56-year-old woman was admitted to our hospital with abdominal fullness and vomiting. She was diagnosed as having ileus of the small intestine by X-ray and CT scan. Three days later, the intestinal decompression was attained by inserting the long intestinal tube. Laparoscopic operation was performed for both diagnosis and treatment. Laparoscopic findings showed incarceration of the small intestine, 30 cm in length, into a defect of the left broad ligament of the uterus. The incarcerated intestine was pulled back without having to excise the intestine, and the hiatus was sutured and closed by laparoscope. There were no postoperative complications. The patient was discharged on the eleventh postoperative day. In the treatment of this disease where preoperative diagnosis is difficult, laparoscopic surgery is a valuable method for both the diagnosis and the treatment.