人工造腟後の内ヘルニアに対し腹腔鏡下で修復した1例

Laparoscopic surgery for internal hernia after vaginoplasty : a case report

◆要旨：患者は39歳，男性．性同一性障害のためS状結腸を用いた造腟術をタイ国で施行された．1か月後，腹痛を主訴に当院を来院した．CT検査で内ヘルニアによる腸閉塞と診断し，保存的加療で改善しなかったために腹腔鏡下手術を行った．腹腔鏡で観察すると人工腟と骨盤腹膜との固定の間隙に小腸が嵌頓していた．そのため腹腔鏡下に内ヘルニア修復術を施行した．また人工腟と骨盤腹膜との固定を外して嵌頓を予防した．造腟術後の内ヘルニアによる腸閉塞の症例の報告は極めて稀であり，人工造腟後の内ヘルニアに対し腹腔鏡下で修復した1例を報告する．

A 39-year-old man with internal hernia after vaginal reconstruction（vaginoplasty） was admitted to our hospital complaining of abdominal pain. He had a gender identity disorder and had undergone sex reassignment surgery. The lining of the reconstructed vagina was made from his sigmoid colon. Since conservative treatment of the hernia showed no results, laparoscopic surgery was performed. Dilated small intestine was found in a space between the reconstructed vagina and the pelvic peritoneum, thus the diagnosis of internal hernia was confirmed and the dilated small intestine was extracted. Some suture threads that connected the reconstructed vagina and pelvic peritoneum were also cut by laparoscopic coagulating shears to prevent recurrence. We report this rare experience of successful laparoscopic diagnosis and treatment of internal hernia after vaginal reconstruction.