大腸穿孔を伴う鼠径ヘルニア嵌頓に対し腹腔鏡下鼠径ヘルニア修復術（TEP法）を施行した1例

A case of totally extraperitoneal repair（TEP） for an incarcerated inguinal hernia with sigmoid colon perforation

◆要旨：患者は69歳，男性．左鼠径部痛を主訴に近医を受診し，左鼠径ヘルニア嵌頓の診断で当科へ紹介となった．腹部単純CT画像にて左鼠径ヘルニア嵌頓によるS状結腸穿孔を認めた．ヘルニア内容物を腹腔内に還納し，ヘルニア囊は高位結紮を行ったうえで双孔式人工肛門造設を施行した．術後経過は良好で術後第19病日に退院となった．人工肛門閉鎖を行ったのち術後7か月経過した段階で腹腔鏡下ヘルニア修復術（totally extraperitoneal repair；以下，TEP法）を行った．以後再発なく経過している．鼠径ヘルニア嵌頓による器質性疾患のないS状結腸穿孔は比較的稀で，人工肛門閉鎖を経てTEP法で修復した例は少ない．その有効性，安全性について若干の文献的考察を加えて考察する．

　Here, we present a 69-year-old male patient who suffered sigmoid colon perforation due to an incarcerated left inguinal hernia. He presented with left inguinal pain and severe abdominal pain. Abdominal computed tomography revealed the sigmoid colon perforation due to an incarcerated left inguinal hernia. We subsequently performed immediate high ligation and laparoscopic-assisted sigmoid colostomy. The postoperative course was uneventful and he was discharged from the hospital on postoperative day 19. Colostomy closure and totally extraperitoneal repair （TEP） of inguinal hernia were performed 7 months after the initial operation. The patient has not had a recurrence of his symptoms to date. Sigmoid colon perforation due to an incarcerated left inguinal hernia in the absence of other organic disorders is relatively rare. We demonstrate the effectiveness and safety of staged colostomy and TEP for such cases.