腹腔鏡手術中の膀胱損傷で診断が得られた鼠径部膀胱ヘルニアの1例

Bladder hernia diagnosed by bladder injury during laparoscopic surgery

◆要旨：患者は49歳，男性．左鼠径部の膨隆と貯尿時の鼠径部痛を主訴に近医を受診し，左鼠径ヘルニアの診断で当院を紹介され受診した．立位で膨隆し，臥位で消失する腫瘤を左鼠径部に認めた．腹腔鏡下鼠径ヘルニア修復術を施行し，脱出臓器は膀胱と考えられた．術中に膀胱損傷をしたが，腹腔鏡下で1層で縫合し，ヘルニアはメッシュにて修復した．術後膀胱造影検査で明らかなリークはなく，第2病日目に退院した．術後3日間ほど肉眼的血尿を認めたが自然軽快した．貯尿時の鼠径部痛も軽快した．

　A 49-year-old man with voiding pain and a left inguinal soft tumor was diagnosed as having an inguinal hernia.The patient was referred to our hospital because of his wish to have the operation performed laparoscopically. Physical examination revealed soft left inguinal mass that appeared in standing position and disappeared in supine position. Transabdominal preperitoneal repair was performed and a small tear measuring approximately one cm was noted at the bladder wall during the operation. Laparoscopic one-layer repair of the bladder injury was performed, and the hernia was repaired laparoscopically with a mesh. Postoperative cystography showed successful repair of the bladder injury. Hematuria continued for three days. The patient has not complained of voiding pain after the operation.