腹腔鏡下手術が有用であった傍下行結腸窩ヘルニアによる絞扼性腸閉塞の1例

A case of laparoscopic surgery for bowel obstruction due to internal hernia at paracolic gutter of the descending colon

◆要旨：患者は腹部手術歴のない62歳，男性．腹部膨満感と徐々に増強する腹痛を主訴に救急搬送された．軽度の腹満を認め，左側腹部に圧痛を認めた．腹部CT検査で下行結腸の背側に迷入する浮腫状の小腸と腸間膜を認め，腹水を伴っていた．以上より内ヘルニアによる絞扼性腸閉塞と診断し緊急で腹腔鏡下手術を施行した．腹腔鏡で観察すると下行結腸外側の腹膜窩にうっ血した小腸が嵌入していた．ヘルニア門を切開し，嵌頓した小腸を整復した．腸切除は行わず，ヘルニア囊を広く開放し手術を終了した．患者は術後4日で退院した．内ヘルニアのなかでも非常に稀である傍下行結腸窩ヘルニアに対して腹腔鏡下手術が有用であった症例を経験したので報告する．

A 62-year-old man was admitted by ambulance because of progressive abdominal pain with distension. Strangulated bowel obstruction due to internal hernia was suspected by CT, and he underwent emergent laparoscopic surgery. A part of the small intestine was incarcerated into the retroperitoneal space through a defect in the paracolic gutter on the left side of the descending colon. The incarcerated intestine was reduced and the hernia hilus was widely opened. Postoperative course was uneventful. In the current case, laparoscopic surgery was useful for the diagnosis and treatment of internal hernia. To our knowledge, only 8 cases of internal hernia at paracolic gutter of the descending colon have been reported in the Japanese literature. We herein report this rare case with literature review.