腹腔鏡下に診断・治療した外側型盲腸周囲ヘルニアの1例

A case of paracecal hernia treated with laparoscopic surgery

◆要旨：患者は78歳，女性．2014年6月，腹痛，嘔吐を主訴に当院を受診した．腹部手術歴はなく，小腸イレウスの診断で入院となった．保存的加療で改善が得られず，内ヘルニアによるイレウスを疑い第14病日腹腔鏡下手術を施行した．腹腔内を観察すると，盲腸の外側尾側へ回腸が嵌頓している盲腸周囲ヘルニアを認め，腹腔鏡下に嵌頓腸管の整復とヘルニア囊の開放を行った．本症例は本邦で頻回に引用される分類にあてはまらず，Meyerらの分類による外側型盲腸周囲ヘルニアであり，術前診断には至らなかったが，腹腔鏡下手術により診断，治療を行うことができた．内ヘルニアは術前診断が比較的困難であり，開腹歴のないイレウス症例において腹腔鏡下手術の有用性が示唆された．

A 78-year-old woman, who had no history of laparotomy, was referred to our hospital with abdominal pain and vomiting. She was admitted with the diagnosis of small bowel obstruction and was treated conservatively. The symptoms did not improve. Ileus due to internal hernia was suspected and on the 14th day after admission, laparoscopic surgery was performed. Operative findings revealed a lateral type of paracecal hernia. A patient with lateral type of paracecal hernia was diagnosed and treated effectively with laparoscopic surgery. In cases of internal hernias including paracecal hernias, preoperative diagnosis is relatively difficult and laparoscopic surgery may be useful for diagnosis and treatment.