外傷性腹壁ヘルニアに対して腹腔鏡下腹壁ヘルニア修復術を施行した1例

A case of traumatic abdominal wall hernia repaired by laparoscopic surgery

◆要旨：患者は52歳，男性．自転車走行中に自動車と衝突して救急搬送され，初診時は左下腹部打撲症として帰宅した．受傷4日目から左下腹部の膨隆が出現して再診した．腹部CTにて腹直筋左下部の断裂と同部位での膀胱の腹壁外への脱出を認めたために外傷性腹壁ヘルニアと診断し，受傷20日目に腹腔鏡下腹壁ヘルニア修復術を施行した．比較的稀な疾患である外傷性腹壁ヘルニアは，腹腔内臓器損傷を伴うことも多く，緊急開腹手術が行われることが多い．しかし，臓器損傷が否定された症例であれば，待機的な腹腔鏡下修復術が施行可能である．感染や術後在院日数，再発率などにおいて優位な本術式は，外傷性腹壁ヘルニアに対しても有用であると考えられた．

　The patient was a 52-year-old man who collided with a car during a bicycle run. Emergency survey was carried out, and he went home as left lower abdominal quadrant contusion at the first medical examination.A bulge of the left lower abdominal quadrant appeared from the 4th day of injury, it was diagnosed as a traumatic ventral hernia at the re-examination,and the elective laparoscopic surgery was performed on the 20th day of injury. Traumatic ventral hernia is a relatively rare disease, often accompanied by abdominal organ damage, and an emergency open surgery is often performed. However, it is possible to perform an elective surgery if organ damage is denied. Laparoscopic surgery is useful for traumatic ventral hernia in infection,hospital stay, and relapse rates.