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◆要旨:患者は50歳女性で,腹痛と嘔吐を主訴に近医より紹介となった.近医での腹部単純X線検査にて小腸イレウスの診断となった.手術既往歴はなく,腹部造影CT検査では,総腸骨動脈分岐レベルで,腸管の口径差を認めた.イレウス管による保存加療を優先することとした.入院後も排ガス,排便を認めず,腹部単純X線上も改善を認めなかったため入院後3日目に腹腔鏡にて手術を行うこととした.腹腔内を観察するとS状結腸間膜が膨隆し,S状結腸間膜左葉に小腸が陥入しておりS状結腸間膜内ヘルニアの診断に至った.同腸管を引き出し,ヘルニア門を体腔内で縫合閉鎖し手術を終えた.術後経過は良好であり術後8日目に退院となった.
A 50-year-old woman was admitted with abdominal pain and vomiting; she had no history of abdominal surgery or injury. An abdominal X-ray examination showed multiple niveaus of the small bowel. Abdominal computed tomography revealed a caliber difference in the intestinal tract at the level of the common iliac artery. The symptoms were very mild and a conservative therapy using an ileus tube was performed; however, no symptomatic remission was achieved. Laparoscopic surgery was performed 3 days after admission. Upon laparotomy, it was observed that the ileum was incarcerated through a hole in the left lobe of the sigmoid mesentery. Consequently, the patient underwent a surgical procedure and was diagnosed with an intramesosigmoid hernia. After the incarcerated ileum was reduced, the hernia orifice was sutured and closed. The patient made a satisfactory recovery and was discharged 8 days after operation.
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