膿瘍形成を伴うde Garengeot herniaに対し二期的に腹腔鏡下ヘルニア修復術を施行した1例

A case of de Garengeot hernia with abscess treated by TAPP procedure after laparoscopic appendectomy

◆要旨：患者は84歳，男性．3日間持続する右鼠径部痛を主訴に当院を受診した．血液検査で炎症反応の上昇を認めた．腹部超音波検査および腹部造影CTで，右大腿ヘルニアの虫垂嵌頓を認め，de Garengeot herniaと診断し，同日緊急手術を施行した．術中所見では右大腿ヘルニア囊内に膿汁の貯留を伴っており，腹腔鏡下虫垂切除術を施行した．感染を伴っていたため，1か月後に大腿ヘルニアはtransabdominal preperitoneal approach（TAPP法）で修復した．大腿ヘルニアの虫垂嵌頓は稀な疾患であり，de Garengeot herniaと称されるが，なかでも虫垂炎を伴う症例においては治療法の選択は議論が分かれる．今回，膿瘍形成性虫垂炎を伴うde Garengeot herniaに対し，腹腔鏡下虫垂切除後の二期的なTAPP法が有用であったため報告する．

　An 84-year-old man visited our hospital complaining of right inguinal pain lasting for three days. The blood examination showed high inflammatory reaction. An abdominal ultrasonography and abdominal enhanced computed tomography（CT） scans revealed incarcerated appendix in the right femoral hernia. The patient was diagnosed as having de Garengeot hernia and emergency laparoscopic surgery was performed. Intraoperative findings showed abscess in the femoral hernia sac, therefore, laparoscopic appendectomy was performed. One month later, transabdominal preperitoneal hernia repair（TAPP） was performed. The incarcerated appendix in the femoral hernia, de Garengeot hernia, is a rare clinical condition. Its treatment, especially for those accompanying appendicitis, is controversial. Here, we report a case of de Garengeot hernia with abscess that was treated by TAPP procedure subsequent to laparoscopic appendectomy.