腹腔鏡下に手術した再発子宮広間膜裂孔ヘルニアの1例

Laparoscopic surgery of recurrent internal hernia through a defect in the broad ligament of the uterus : a case report

◆要旨：患者は51歳，女性．2006年2月に左子宮広間膜ヘルニア嵌頓による絞扼性イレウスで開腹イレウス解除術を施行した．ほかに特記すべき既往歴はない．2007年9月，10月とイレウス症状が出現したが，保存的に軽快していた．2008年1月，左下腹部痛を主訴に来院した．腹部CTにて，骨盤内に拡張した小腸と右側へ圧排された子宮を認め，左子宮広間膜ヘルニア嵌頓による絞扼性イレウスと診断し，腹腔鏡下に緊急手術を施行した．左子宮広間膜裂孔に約30cmの回腸が嵌入していたが，血流障害は認めなかった．嵌入していた小腸を引き出し，欠損部をクリッピングにて修復した．術後1年，再発はなく経過している．子宮広間膜裂孔ヘルニアは稀な疾患であるが，腹腔鏡下手術のよい適応と考えられる．

　We report a rare case of internal hernia through a defect in the broad ligament of the uterus. A 51-year-old woman who had laparotomy without enterectomy for internal hernia through a defect in the broad ligament of the uterus two year before was admitted for sudden left lower abdominal pain. A pelvic computed tomography indicated displacement of the uterus toward the right side and existence of a dilated small intestine in Douglas pouch. Intestinal obstruction due to a hiatal hernia of the left broad ligament of the uterus was diagnosed and laparoscopic emergency-surgery was performed. The ileum, approximately 30 cm in length that incarcerated into a 3 cm-sided fissure of the left broad ligament of the uterus was released without enterectomy and the hiatus was repaired. Laparoscopic surgery is effective for internal hernia through a defect in the broad ligament of the uterus.