嵌頓大腿ヘルニアに対して腹腔鏡下ヘルニア修復術を施行した1例

Laparoscopic repair of incarcerated femoral hernia

◆要旨：患者は84歳，女性．腹痛にて当科に紹介され受診となった．左鼠径部の鼠径靭帯尾側に10cm大の膨隆を認めた．腹部X線検査，腹部CT検査で左嵌頓大腿ヘルニア，ヘルニア内には造影効果の保たれた腸管が嵌頓していると考えられ，腹腔鏡下緊急ヘルニア修復術を施行した．鉗子で小腸を牽引したが嵌頓が解除されなかったために左iliopubic tractを部分的に切開し大腿輪を開大することにより嵌頓を解除した．腸管の色調も次第に改善し，腸切除は不要と考えられたため，腹腔鏡下にBard 3D meshを用いてヘルニアを修復した．術後経過は問題なく第11病日に退院した．術前CTで嵌頓腸管の血流障害がないと判断される症例に対しての緊急腹腔鏡下ヘルニア修復術は有用であると考えられた．

　We report a patient with incarcerated femoral hernia treated laparoscopically. An 84-year-old woman was admitted to our hospital, complaining of abdominal pain. She had a soft tumor, 10 cm in diameter, below the left inguinal ligament. Abdominal X-ray and computed tomography（CT）showed the herniated intestine filled with intestinal gas, and left incarcerated femoral hernia was diagnosed. The strangulated intestine had shown the enhancement with contrast CT imaging. We performed emergency surgery with a laparoscopic approach. Laparoscopy showed that the small intestine was herniated into the left femoral canal. We failed to release the intestine using laparoscopic forceps because the small intestine was strangulated so hard. After cutting the iliopubic tract partially, the strangulated intestine was easily released. Hernia space was reparied using a piece of Bard 3 D mesh laparoscopically after confirming that the color of the strangulated portion of the intestine ameliorated. . Postoperative course was uneventful, and the patient was discharged on the postoperative day 11. Laparoscopic repair is a good option for incarcerated hernia without ischemia of the intestine.