単孔式腹腔鏡下手術を施行したWinslow孔ヘルニアの1例

A case of herniation through foramen of Winslow treated with single incision laparoscopic surgery

◆要旨：患者は29歳，女性．来院前日から続く上腹部痛のため当院を受診した．腹部造影CT検査で網囊内の拡張した小腸とその腸間膜がWinslow孔に収束する所見を認め，Winslow孔ヘルニアと診断した．絞扼所見を認めなかったためイレウス管による減圧を行い，待機的単孔式腹腔鏡下手術を施行した．視野は良好で嵌入小腸の整復のみで終了し，Winslow孔の閉鎖は行わなかった．術後経過良好で術後8日目に退院し，術後8か月現在再発はない．Winslow孔ヘルニアは稀な疾患であるが，特徴的なCT所見から術前診断は可能である．血流障害のない症例で術前に十分減圧を行えば，単孔式腹腔鏡下手術は可能であると考えられた．

A 29-year-old woman was seen in the emergency department of our hospital with a 24-hour history of upper abdominal pain. An abdominal contrast-enhanced CT scan showed a dilated small intestine in the omental bursa and the mesentery converged to the foramen of Winslow, therefore we made a diagnosis of herniation through the foramen of Winslow. Because there were no strangulation findings, we performed the decompression of small intestine with a long intestinal tube, and then performed elective single incision laparoscopic surgery. We simply released the incarcerated small intestine under a satisfactory view, and did not close the foramen. She recovered well and was discharged on postoperative day 8. She has no recurrence for eight months after surgery. Although herniation through the foramen of Winslow is a rare disease, it is possible to diagnose preoperatively because of characteristic CT findings. Single incision laparoscopic surgery can be applied to this herniation in cases with no strangulation findings, and when the bowels are well-decompressed preoperatively.