経腹的腹膜前修復法（TAPP法）術後血腫による腹部コンパートメント症候群（ACS）の1例

Abdominal compartment syndrome caused by preperitoneal hematoma following transabdominal preperitoneal hernia repair : A case report

◆要旨：患者は69歳，男性．57歳時に僧帽弁置換術を施行され，ワルファリン内服中であった．右鼠径ヘルニアの診断で，ヘパリン置換後に，TAPP法を施行した．術後4日目にショック状態となり，術後出血の診断で輸血を施行した．術後6日目，CTにて血腫は増大し，膀胱内圧が33mmHgと上昇しており，腹部コンパートメント症候群と診断した．同日，緊急手術を施行した．膀胱前腔に多量に血腫を認め，出血源は恥骨結節周囲からの可能性が考えられた．術後経過良好で，再手術後21日目に退院した．今回筆者らは，TAPP法術後血腫による腹部コンパートメント症候群の1例を経験したので，文献的考察を加え報告する．

The patient was a 69-year-old man who underwent mitral valve replacement for mitral valve stenosis at 57 years of age. The patient was taking warfarin for thromboembolism prevention. A transabdominal preperitoneal hernia repair was performed for a right inguinal hernia; subsequently, the patient was switched from warfarin to heparin. Heparin use was initiated on postoperative day 2. The patient went into shock on postoperative day 4; therefore, blood transfusion was performed. Abdominal computed tomography revealed an enlarged hematoma with an increased intrabdominal pressure of 33 mmHg on postoperative day 6. He was then diagnosed with abdominal compartment syndrome. An emergency laparotomy and evacuation of the hematoma was performed, and the postoperative prognosis was good. The cause of bleeding was considered to small vessels of surrounding pubis. Eventually, he was discharged on postoperative day 21.