腹腔鏡が診断・治療に有用であった内膀胱上窩ヘルニアの1例

A case of internal supravesical hernia successfully diagnosed and treated by laparoscopy

◆要旨：患者は68歳の男性で，腹痛と嘔気の主訴で近医を受診した．イレウスと診断され当院に紹介となった．腹部CT検査にて右下腹部に膀胱を圧排するように拡張した小腸係蹄を認め，その口側の腸管に拡張を認めた．内ヘルニアの嵌頓によるイレウスを疑い腹腔鏡下手術を施行した．腹腔鏡下所見では回腸が膀胱上窩に嵌頓しており，内膀胱上窩ヘルニア嵌頓と診断し，腸管を整復してヘルニア門を広く開放した．術後経過は良好であった．内膀胱上窩ヘルニアは稀な疾患で，外科医の認知度も低いため術前診断は困難とされている．しかし，そのCT所見はきわめて特徴的であり，本疾患が念頭にあれば容易に診断可能と思われた．また本症例ではその診断・治療に腹腔鏡が非常に有用であった．

　A 68-year-old man was referred to our hospital because of intestinal obstruction. Abdominal computed tomography（CT）demonstrated a dilated ileal loop invaginating towards the bladder at the right lower abdomen. Internal hernia was suspected and emergency laparoscopic procedure was performed. Laparoscopic observation demonstrated the ileum was incarcerated into the right supravesical fossa. We reintegrated the incarcerated ileum and widered the hernia orifice to prevent incarceration. The patients postoperative course was uneventful. Internal supravesical hernia is very rare and the preoperative diagnosis is difficult because surgeons usually do not take it into consideration. However, the CT findings of this condition are extremely pathognomonic and can contribute to preoperative diagnosis. In this case, although we could not make a correct diagnosis preoperatively, laparoscopic procedure was very useful for diagnosis and treatment.