傍下行結腸窩ヘルニアによるイレウスに対し腹腔鏡下手術が有用であった1例

Ileus due to internal hernia at the paracolic gutter of the descending colon successfully treated by laparoscopic surgery : a case report

◆要旨：傍下行結腸窩ヘルニアの本邦報告は自験例を含めて7例と稀である．今回，傍下行結腸窩ヘルニアの1例を経験したので文献的考察を含め報告する．患者は70歳，男性．下部消化管内視鏡検査後より腹痛，嘔吐を認め，小腸イレウスと診断され，精査加療目的で入院となった．CT，イレウス管造影で内ヘルニアを疑った．イレウス管挿入後も症状の改善を認めず，腹腔鏡下手術を行った．下行結腸の外側に径2cmのヘルニア門を認め，そこに小腸が約15cm嵌頓しており，傍下行結腸窩ヘルニアによるイレウスと診断した．嵌頓している小腸を整復し，ヘルニア門は縫合閉鎖した．術後再発は認めず，腹腔鏡下手術は鑑別診断と治療に有用であった．

　An internal hernia at the paracolic gutter of the descending colon is very rare, and only 6 cases have been reported so far in the Japanese literature. We herein report our case and summarize the 7 cases. A 70-year-old man was admitted to the hospital because of abdominal pain and vomiting after colonofiberscopy. Intestinal obstruction due to an internal hernia was suspected by CT. Since the symptom did not improve after the placement of the ileus tube, laparoscopic surgery was performed. A part of the small intestine, approximately 15 cm in length, was incarcerated into the retroperitoneal space through a 2.0 cm defect of the paracolic gutter on the left side of the descending colon. The intestine was returned to the abdominal cavity and the hernial hilus was closed. The postoperative course was uneventful. Laparoscopic surgery is useful for the diagnosis and treatment of the patient with a suspected internal hernia.