術前に右鼠径ヘルニア偽還納と診断し腹腔鏡下手術を行った1例

Laparoscopic surgery for reduction en masse of an inguinal hernia : A case report

◆要旨：患者は55歳，男性．2〜3年前から右鼠径部の膨隆を認めたが，その都度自己還納していた．前日の夜からの腹痛，右鼠径部の腫大，頻回の嘔吐を主訴に当院を受診した．腹部CT所見では，骨盤内に囊状に包まれ拡張した小腸とその周囲に腹水を認めたため，鼠径ヘルニア偽還納によるイレウスと診断した．第二病日，小腸の減圧目的でイレウス管を挿入し，第三病日，腹腔鏡下手術を施行した．回腸が外側臍襞と内側臍襞の間の壁側腹膜に陥入し腹膜前腔に腫瘤を形成していた．ヘルニア門を形成する肥厚した腹膜を切開し嵌頓を解除し，鼠径ヘルニアについては通常のtransabdominal preperitoneal approach（TAPP）法でメッシュを用いて修復した.

A 55-year-old man was referred to our hospital because of abdominal pain, right inguinal swelling and vomiting that started from the previous night. For the past few years, the patient has repeatedly performed manual reduction of the right inguinal hernia. CT scan revealed an edematous small intestine and fluid in a cystic mass, thus, we diagnosed the case as reduction en masse of an inguinal hernia. We inserted a long tube for decompression and performed laparoscopic operation the next day. Laparoscopic finding revealed a mass consisting of small intestine that had incarcerated into the preperitoneal space medial to the inferior epigastric artery. We cut the hypertrophic peritoneum, reduced the incarceration, and repaired the hernia using a mesh by transabdominal preperitoneal approach（TAPP）.