腹腔鏡下鼠径ヘルニア手術で用いた金属性コイル式タックの遅発性脱落による術後イレウスの1例

A case of postoperative ileus caused by a slipped down staple used for laparoscopic inguinal hernia repair

◆要旨：患者は72歳，男性．既往歴として前立腺全摘術，腹腔鏡下鼠径ヘルニア修復術を施行されていた．2008年，心窩部痛を主訴に当院を受診し，術後癒着性イレウスの診断にて入院となった．保存的に加療したが改善をみず，開腹手術を施行した．腹腔内を観察すると，金属性コイル式タックが小腸に2か所ねじ込むように刺さり小腸が固定され，腸管が捻転することで腸閉塞を起こしていた．腹腔鏡下ヘルニア修復術時に使用した金属性コイル式タックが遅発性に自然落下して起きた腸閉塞であった．術中にステイプルを落下させないことと，将来的にステイプルが腹腔内に脱落しないような固定が重要であると思われた．ステイプルを遊離腹腔内に落下させた場合には，可能な限り回収する必要があると考えられる．

　This case involved a 72-year-old male patient with a history of prostatectomy and laparoscopic inguinal hernia repair. In 2008, the patient visited our hospital complaining of epigastric pain, and was admitted with a diagnosis of postoperative intestinal obstruction. The patient did not improve with conservative medical treatment, and underwent abdominal surgery. Observation of the abdominal cavity showed that a fallen ring staple used in the previous laparoscopic inguinal hernia repair had twisted into two adjacent parts of the small intestine, where it had become embedded, thus causing intestinal obstruction. The postoperative course was uneventful , and no recurrence of ileus has occurred thereafter. When fallen staples are not removed, they can result in intestinal obstruction in the future. This suggests a need for a means of preventing objects from falling during surgery and for a search and recovery when they do fall. We have compiled this report for bibliographic consideration, since there have been very few reports on obstruction caused by fallen staples.