術前診断しreduced port surgeryにて修復した子宮広間膜裂孔ヘルニアの1例

A case of internal hernia through a defect of the broad ligament of the uterus, treated by reduced port surgery

◆要旨：子宮広間膜ヘルニアは，子宮広間膜裂孔をヘルニア門として生じる比較的稀な内ヘルニアである．今回，術前CTで診断した子宮広間膜裂孔ヘルニアをreduced port surgery（RPS）にて修復した1例を経験したので報告する．患者は53歳女性で，腹痛と嘔吐を主訴に当科を受診した．腹部造影CTにて骨盤内の拡張した小腸，偏位した子宮および子宮と卵巣の間に小腸絞扼部を認め，子宮広間膜ヘルニアと診断し，腹腔鏡下手術を施行した．嵌頓小腸を還納し，異常裂孔を縫合閉鎖することで手術を終了した．術後7日目に軽快退院した．本症例のように術前診断できれば小腸の拡張を認めていてもRPSで安全に手術が可能であると考えられた．

　A case of internal hernia through a defect of the broad ligament of the uterus was reported. A 53-year-old woman complaining of sudden abdominal pain and vomiting was admitted to our hospital. Abdominal multi-detector CT revealed an ileus caused by an internal hernia through the broad ligament of the uterus. We performed an emergency laparoscopic reduced port operation. We found that the ileum was incarcerated in a defect of the left broad ligament, and we pulled out the incarcerated ileum from both the oral and anal sides. The incarcerated small bowel was slightly edematous but not ischemic, so we did not resect it. The defect was closed with a simple running suture via laparoscopy. After an uneventful postoperative course, the patient was discharged 7 days later. Internal herniation through a defect in the broad ligament of the uterus is extremely rare, and a precise diagnosis is difficult. In this case, multi-detector CT was useful for diagnosing this type of defect preoperatively, whereby open surgery was avoided and reduced port surgery was undertaken.