腹腔鏡下に修復した傍十二指腸ヘルニアの1例

Laparoscopic repair of paraduodenal hernia : a case report

◆要旨：患者は60歳，女性．嘔気・嘔吐を主訴に受診した．外来で精査を行ったが診断がつかず，経過観察とした．初診から約3週間後に嘔吐と左上腹部痛も出現したために再受診となった．その際の腹部CT検査で初めて傍十二指腸ヘルニアの診断を得た．治療は腹腔鏡下に嵌入した空腸を腹腔内に還納した後，ヘルニア門を縫合閉鎖し修復した．術後6日目に軽快，退院した．腹腔鏡下手術の普及により，内ヘルニアの修復術に対する腹腔鏡による手術治療の報告例が近年増加している．傍十二指腸ヘルニアに対しても腹腔鏡下修復術は安全かつ有用な術式であると考えられた．

　A 60-year-old woman visited our department with a chief complaint of nausea and vomiting. Various examinations performed at the outpatient clinic failed to yield a diagnosis. After 3 weeks of follow-up, in addition to vomiting, left epigastric pain developed, and the patient was re-examined. Abdominal CT subsequently led to a diagnosis of paraduodenal hernia. The incarcerated jejunum was laparoscopically reduced back into the abdominal cavity, and the hernia orifice was closed with sutures to complete hernia repair. On the sixth postoperative day, she was discharged with symptomatic improvement. The spread of endoscopic surgery has resulted in a recent increase in the number of reported cases of endoscopic repair of internal hernias. We consider that laparoscopic repair of paraduodenal hernia is a safe and useful procedure.