肝細胞癌に対するラジオ波焼灼術後の右横隔膜ヘルニア横行結腸嵌頓に対して腹腔鏡下修復術を施行した1例

Laparoscopic right diaphragmatic hernia repair for incarcerated transverse colon after radiofrequency ablation of hepatocellular carcinoma : A case report

◆要旨：RFA後の遅発性横隔膜ヘルニアに対し腹腔鏡下手術にて治療できた1例を報告する．患者は49歳，男性．肝細胞癌に対して9年前にRFAを施行された．間欠的腹痛を主訴に当院を受診した．CTにてRFA後の遅発性右横隔膜ヘルニアへの横行結腸嵌頓と診断した．明らかな大腸壊死を疑う所見がなかったため腹腔鏡下手術を選択した．横隔膜に嵌頓した結腸は愛護的な牽引では整復できず，ヘルニア門を切開し整復した．ヘルニア門を2-0非吸収糸で縫合閉鎖後に15×10cmのメッシュを留置固定した．術後4日で退院し合併症を認めなかった．RFA後の遅発性横隔膜ヘルニアに対する腹腔鏡下修復術は，安全で有用な方法と考えられた．

A 49-year-old man with a history of hepatocellular carcinoma treated with radiofrequency ablation（RFA） 9 years ago presented with intermittent abdominal pain for the past 4 days. A CT scan revealed liver cirrhosis and a right diaphragmatic hernia with an incarcerated transverse colon.　We chose a laparoscopic approach because his vital signs were stable and bowel necrosis was unlikely. The reduction was not possible with gentle traction; we needed to cut the hernia orifice to reduce it. After the closure with 2-0 non-absorbable suture, the suture line was reinforced using 15×10cm mesh. Four days after the operation, the patient was discharged without complications. Laparoscopic repair of diaphragmatic hernia after RFA seems to be an effective and safe treatment approach.