腹腔鏡下手術で整復しえたWinslow孔ヘルニアの1例

Laparoscopic treatment for Winslow foramen hernia

◆要旨：患者は25歳，男性で，手術歴のない急性腹症の診断で入院した．腹部単純X線検査では，胃の著明な拡張と胃の頭側に拡張したガス像を認めた．イレウス管による保存的治療で一時的には軽快したが，飲水により再び腹痛が出現した．この後のCT検査では，小腸は肝左葉，胃小彎，肝十二指腸靭帯に囲まれ，造影では管の先端は網囊内にあり内ヘルニアと診断し，ヘルニア門はWinslow孔と考えられた．保存的治療は困難と判断し，腹腔鏡下に手術を行った．本疾患では比較的特徴的な画像所見を示し，術前診断により腹腔鏡下の手術が可能と考えられる症例であった．Winslow孔ヘルニアは稀な疾患であり，腹腔鏡下で整復しえた症例として報告する．

　A 25-year-old man with abdominal pain was admitted to our hospital. A plain abdominal X-ray film revealed distended stomach gas and small intestinal gas in the cranial part of the lesser curvature of the stomach. Although conservative therapy was performed, it was not effective. On abdominal CT scan, the distended small intestine was situated in a portion surrounded by the dorsal aspect of the left lobe of the liver , lesser curvature of the stomach and ligament hepatoduodenale. On small bowel series, the apex of long tube was observed in the omental sac. The diagnosis of Winslow foramen hernia was made and laparoscopic surgery was carried out on the 11^th day after onset of symptoms. Winslow foramen hernia often shows comparatively distinctive findings on abdominal CT scan, so that rapid diagnosis and treatment by laparoscopic surgery is a good option for the patient.