大腿ヘルニア偽還納による絞扼性イレウスに対して腹腔鏡下手術を施行した1例

Laparoscopic surgery for strangulated ileus due to femoral hernia reduction en masse : a case report

◆要旨：患者は71歳，女性．右大腿ヘルニア嵌頓の診断にて緊急手術を施行した．嵌頓を解除するとヘルニア囊は還納されたため，ヘルニア囊に対して高位結紮は行わず，inlay mesh法を施行した．術後にイレウスが改善せず，腹腔鏡下にて緊急手術を施行したところ，腹壁に癒着した小腸がヘルニア囊と一体となっており，偽還納の状態であった．絞扼腸管をヘルニア囊から解除し，小腸部分切除術を施行した．絞扼輪となっていたヘルニア囊は縫合閉鎖した．ヘルニア還納後にもイレウスが改善しない場合は，偽還納を念頭に置く必要がある．腹腔鏡下手術は，偽還納に対して確実な診断と低侵襲治療が可能であり，有用であることが示唆された．

　A 71-year-old female who was diagnosed as having incarcerated right femoral hernia underwent an emergency operation. The hernia sac was released from the right femoral canal and incarceration was removed. The repair was performed by inlay mesh method without high ligation of hernia sac because the incarcerated small intestine was not ischemic. Since the symptoms of intestinal obstruction did not improve after the operation, emergency laparoscopic surgery was performed. The ileum which adhered to the abdominal wall was united with the hernia sac, and diagnosis of femoral hernia reduction en masse was made. We removed the strangulated ileum from the hernia sac, performed partial resection of the small intestine, and sutured the strangulated ring. It is necessary to consider the possibility of hernia reduction en masse when ileus does not improve after repositioning or operation. Laparoscopic surgery was considered to be useful for inguinal and femoral hernia reduction en masse. To our knowledge, this is the first reported case of femoral hernia reduction en masse in Japan.