腹腔鏡補助下に整復しえた大網裂孔ヘルニアの1例

Laparoscopic surgery for transomental hernia : A case report

◆要旨：患者は24歳，女性．嘔吐，腹痛を主訴に救急搬送された．腹部骨盤造影CTで小腸に狭窄を2か所認め，closed loopを形成した小腸が網囊内へ陥入していた．大網裂孔ヘルニアによる絞扼性腸閉塞を疑い，緊急手術を施行した．腹腔鏡で観察すると小腸は著明に拡張しており，横隔膜下や骨盤腔に血性腹水を中等量認めた．大網に裂孔があり網囊内に小腸が嵌頓していた．嵌頓を解除後，再発予防のためヘルニア門となった大網を切離し開放した．その後，うっ血した小腸を約40cm切除した．術後経過は良好で術後15日目に退院となった．本症例のような大網裂孔ヘルニアにより腸閉塞をきたした症例に対して，腹腔鏡下手術は有用であると考えられた．

A 24-year-old woman presented to the emergency department at our hospital with acute vomiting and abdominal pain. Computed tomography revealed small intestinal strictures and closed-loop obstruction. We suspected transomental hernia, and performed emergency laparoscopic surgery. During surgery, we observed dilated small intestine and moderate bloody ascites under the diaphragm and in the cavitas pelvis. We also observed incarcerated small intestine at the omental hiatus. After the hernia repair, we cut the omentum and opened the omental hiatus to prevent the recurrence of hernia. Then, we resected approximately 40 cm of the congested small intestine. The postoperative course was uneventful and the patient was discharged on the 15th postoperative day. We consider laparoscopic surgery to be effective for ileus caused by transomental hernia.