腹腔鏡下で診断，根治術を行った横行結腸間膜裂孔ヘルニアの1例

A case of transmesocolic hernia of transverse colon diagnosed and treated laparoscopically

◆要旨：患者は90歳の女性で，虫垂切除術，高血圧，糖尿病，胆囊総胆管結石内視鏡的治療の既往があった．虚血性腸炎の治療のため当院内科に入院中，胆汁性嘔吐で発症した．腹部CTで小腸closed loopを認め絞扼性腸閉塞と診断され外科紹介となり緊急手術を行った．腹腔鏡下に癒着を剝離したところ，横行結腸間膜の約3cm大の裂孔に空腸が嵌入していた．鉗子にて還納した腸管は壊死に至っていなかったため，腸管切除は行わず，腹腔鏡下に裂孔を連続縫合し閉鎖した．経過は順調で術後10日目に退院した．横行結腸間膜裂孔ヘルニアは内ヘルニアの中でも非常に稀であり，早期に診断すれば腹腔鏡下手術が有用な疾患と考えられたので報告する．

　A 90-year-old female who had been admitted at our hospital for the treatment of ischemic colitis complained of bilious vomiting. The patient had past medical history of appendectomy, hypertension, diabetes mellitus and cholelithiasis. An abdominal computed tomography revealed a closed loop of the small intestine. She was diagnosed with intestinal strangulation and was referred to the department of surgery. Emergency laparoscopic surgery was performed. After laparoscopic division of the peritoneal adhesions, a defect measuring approximately 3cm in diameter was found in the transverse mesocolon. Part of the jejunum had incarcerated into the defect. The herniated bowel loop was reduced by traction with forceps and no necrosis was observed. Therefore, the hernial orifice was closed by running suture without jejunal resection. Post-operative course was uneventful and she was discharged on day 10 after the operation. Transmesocolic hernia of the transverse colon is very rare in internal hernias and laparoscopic surgery is useful if diagnosed early.