腹腔鏡補助下左結腸切除術後，温存した下腸間膜動脈と腸間膜欠損部とで形成された間隙に生じた内ヘルニアの1例

Internal hernia through the mesenteric opening rimmed with the mesocolon and the preserved inferior mesenteric artery after laparoscopic-assisted left colectomy: report of a case

◆要旨：患者は63歳，女性．下行結腸癌に対して腹腔鏡補助下左結腸切除術を実施した，左結腸動脈は根部で離断し，下行結腸・腸間膜を切除し，腸間膜欠損部は閉鎖しなかった．術後，腸閉塞を発症し手術を行ったところ，前回手術で温存した下腸間膜動脈と腸間膜欠損部とで形成された間隙に小腸が嵌入し，内ヘルニアとなっていた．癒着を剝離し，小腸を還納後，間隙を閉鎖した．

　腹腔鏡補助下大腸切除術後に腸間膜欠損部が原因で内ヘルニアをきたした例はいくつか報告されているが，温存した血管柄も関与していた例は稀であった．このような合併症を回避するためには，腹腔鏡下手術においても可能であれば開腹術と同様に腸間膜欠損部を閉鎖するのがよいと考えられた．

　A 63-year-old woman underwent laparoscopic-assisted left colectomy for descending colon cancer, in which the root of the left colic artery was transected and the discending mesocolon and colon was resected without closure of the mesenteric aperture. She developed postoperative small bowel obstruction and surgical intervention revealed an internal hernia through the mesenteric opening rimmed with the mesocolon and the preserved inferior mesenteric artery. The obstruction was relieved by adhesiolysis, and the hernia orifice was sutured and closed.

Some cases of internal herniation through the mesenteric defect have been reported after laparoscopic-assisted colorectal resection, however, the preserved artery has rarely been involved in those postoperative complications. The mesenteric defect in laparoscopic-assisted surgery may be closed as in open laparotomy, whenever possible, for preventing a postoperative internal hernia through the mesenteric opening.