膵頭部嵌頓による胆汁うっ滞を伴った巨大食道裂孔ヘルニアを腹腔鏡下に修復した1例

Laparoscopic surgery for giant hiatal hernia with cholestasis due to pancreatic head incarceration

◆要旨：膵頭部が嵌頓し，胆汁うっ滞をきたした稀な巨大食道裂孔ヘルニアの手術例を経験したので報告する．患者は74歳，女性．肝機能障害の精査で巨大な食道裂孔ヘルニアを認めた．上部消化管造影では胃軸捻転を伴い全胃が縦隔内に脱出したupside down stomachを認めた．CTでは胃，膵頭部，横行結腸や小腸が縦隔内に脱出しており，MRCPでは胆管が頭側に変位し胆管の拡張を認めた．肝胆道系酵素の上昇を認めたが，胆管炎や膵炎はなく，消化器症状も認めなかった．待機的に腹腔鏡下食道裂孔ヘルニア修復術を施行した．術後，肝機能障害は改善し，ヘルニアの再発を認めていない．

We herein report a rare case of giant hiatal hernia with cholestasis due to pancreatic head incarceration into the mediastinum treated by laparoscopic surgery. A 74-year-old woman was admitted for giant hiatal hernia and liver dysfunction. Esophagogastrography revealed an upside down stomach with organoaxial volvulus of the stomach. Computed tomography showed herniation of the stomach, pancreatic head, transverse colon and small intestine into the mediastinum. Magnetic resonance cholangiopancreatography showed bile duct dilation. Blood chemistry showed elevated levels of enzymes released from the hepatobiliary system. The patient had no cholangitis or pancreatitis and did not complain of any digestive symptoms. Laparoscopic repair was performed electively. Liver dysfunction was improved, and there is no recurrence of hiatal hernia.