腹腔鏡下に修復できた横行結腸間膜裂孔ヘルニアの1例

Transverse mesocolon hernia treated by laparoscopic surgery : a case report

◆要旨：患者は86歳，男性．20年前に上腹部正中切開で胆囊摘出術の既往があった．2日前から胃痛と嘔気を認め，痛みが改善しないため当院救急外来を受診した．CTで右上腹部にclosed loop所見を認め，絞扼性イレウスの診断で緊急手術の方針とした．腹腔鏡下に手術を開始した．横行結腸間膜に約3cmの裂孔を認め，同部に嵌入する小腸を確認した．小腸は腹腔鏡下に還納することができ，虚血性変化は認めなかった．ヘルニア門を縫合閉鎖して手術を終了した．術後の経過は良好で術後6日目に退院した．本邦にて腹腔鏡下で修復しえた横行結腸間膜ヘルニアの症例は自験例含め3例のみであった．今回，非常に稀な症例を経験したので，文献的考察を加えて報告する．

The patient was a 86-year-old man. He had a history of cholecystectomy with an incision in the abdominal midline 20 years ago. He complained nausea and stomach pain which persisted for 2 days. We found a closed loop small intestine in the upper right abdomen by CT, perormed emergency surgery with the diagnosis of strangulated bowel obstruction. We started the surgery by laparoscopic surgery. It was confirmed that the small intestine invaginated into transverse mesocolon, via a hiatus. The small intestine was removed from the mesocolon by laparoscopic procedure. Since no ischemic changes were found, the hernia ring was sutured and the surgery was over. He was discharged on 6POD with a satisfactory progress after surgery. Only three cases of transverse mesocolon hernia that were repaired laparoscopically are reported in Japan, including our case. We thus report here a rare case.