腹腔鏡補助下胃切除・Roux-en-Y再建術後に発症したPetersen's herniaの1手術例

Petersen's hernia after laparoscopy-assisted distal gastrectomy with antecolic Roux-en Y reconstruction

◆要旨：患者は62歳，男性．早期胃癌に対して腹腔鏡補助下幽門側胃切除・Roux-en Y再建術を受けクリニカルパスどおり10日目に退院した．退院後7日目に急性腹症の診断にて当科を紹介された．腹部CTで少量の腹水貯留と上腸間膜動脈周囲血管の螺旋像を認め，施行手術とCT所見からPetersen's herniaによる内ヘルニアを疑い同日緊急手術を行った．開腹すると，挙上空腸と横行結腸の間隙に小腸の大半が嵌入していた．嵌入小腸を還納し，間隙を大網で閉鎖した．術後経過は良好で10日目に退院となった．腹腔鏡下胃切除術後の内ヘルニア報告は少ないものの，腹腔鏡下手術が普及するにつれ増加しており，術後注意すべき合併症と考えられた．

　A 62-year-old man with early gastric cancer underwent laparoscopy-assisted distal gastrectomy. Seven days after the discharge, he was admitted urgently with severe abdominal pain. Physical examination revealed no findings of peritonitis. Abdominal CT scan showed a little ascites around the liver and vessels caught around the superior mesenteric artery, suggesting Petersen's hernia. Emergency surgery was performed under the suspected diagnosis of internal hernia. Almost all of the small intestine was impacted in the space between the transverse colon and the jejunum and was elevated via the antecolic pathway. There were no findings of ischemic changes in the herniated intestine, so we replaced it and covered the space with the greater omentum. The patient was discharged on the 10th postoperative day uneventfully. We report a case of Petersen's hernia after laparoscopy-assisted distal gastrectomy.