右鼠径ヘルニア術後（mesh plug法）の再発閉鎖孔ヘルニアに対して最終的にmesh sheetを使用した腹腔鏡下修復術を施行した1例

A case of laparoscopic mesh sheet repair for recurrent obturator hernia with a history of mesh plug repair for inguinal hernia

◆要旨：患者は86歳，女性．右下腹部の違和感と嘔吐で受診した．CTで右閉鎖孔ヘルニアによる腸閉塞と診断し，緊急腹腔鏡下修復術を施行した．既往として6年前に右鼠径ヘルニア術後であったため，子宮および卵管をヘルニア門に縫着した．しかし，その7か月後に再発し，再度緊急腹腔鏡下修復術を施行した．縫着した子宮・卵管はすべて外れており，Richter型の腸管嵌頓を認めた．腸管壊死はなく，mesh sheetを用いて修復した．閉鎖孔ヘルニアに対する腹腔鏡下手術は低侵襲で嵌頓腸管を観察可能な点で有用である．修復方法は再発の点からmesh sheetを用いた修復術を第一選択とする必要がある．

　An 86-year-old female presented to our hospital with right lower abdominal pain and vomiting. Abdominal computed tomography（CT） scan showed intestinal obstruction and a right incarcerated obturator hernia requiring an emergency operation. We chose to cover the hernia with the uterus and oviduct due to her history of mesh plug repair for right inguinal hernia. After 7 months of the first repair, recurrence of right incarcerated obturator hernia occurred and lead to emergency laparoscopy. The uterus and oviduct patch were worn off and a Richter type hernia had occurred. After removing the small intestine and confirming its viability, we performed mesh sheet repair. Laparoscopic approach is minimally invasive and useful for assessing the viability of the incarcerated intestine. Laparoscopic mesh sheet repair is superior in terms of recurrence prevention.