両側大腿ヘルニア嵌頓に対して腹腔鏡下手術を施行した1例

A case of laparoscopic repair for incarcerated bilateral femoral hernia

◆要旨：患者は70歳，女性．上腹部痛を主訴に当院へ搬送された．両側鼠径靱帯直下の大腿部に発赤を伴う腫脹を認めた．腹部CTで両側大腿ヘルニア嵌頓と診断し，腹腔鏡下に緊急手術を行った．両側とも鉗子による牽引で嵌頓の整復が可能であった．ヘルニア門はメッシュを用い，transabdominal preperitoneal approach （TAPP法）で修復した．術後5日目に軽快退院となった．大腿ヘルニア嵌頓に対する腹腔鏡下修復術はいまだ標準術式とはなっておらず，文献的報告も少ない．今回，両側大腿ヘルニア嵌頓に対して腹腔鏡下に嵌頓整復とヘルニア修復を行い良好な経過を得た1例を経験したので，若干の文献的考察を加えて報告する．

We report a patient with incarcerated bilateral femoral hernia treated laparoscopically. A 70-year-old woman was admitted to our hospital, complaining of abdominal pain. She had a soft and swelling tumor with redness, just below the bilateral inguinal ligament. Abdominal computed tomography revealed herniated intestine and greater omentum from the right femoral ring, and herniated greater omentum from the left femoral ring. We diagnosed as bilateral incarcerated femoral hernia and performed emergency surgery laparoscopically. We successfully pulled out the incarcerated intestine and greater omentum with laparoscopic forceps. Then we repaired the hernia using polyester mesh by transabdominal preperitoneal（TAPP） technique. The patient was discharged on the fifth day after surgery, uneventfully. Laparoscopic approach for incarcerated femoral hernia has not been the standard, but it can diagnose and repair hernia precisely and less invasively than the anterior approach. Laparoscopic approach will be a good option for incarcerated femoral hernia.