腹腔鏡下に修復した成人右側Bochdalek孔ヘルニアの1例

A case of laparoscopic repair for adult right-sided Bochdalek hernia

◆要旨：患者は70歳，女性．右側腹部痛と嘔吐を主訴に当院を受診した．胸腹部造影CTにて右横隔膜ヘルニアによる腸閉塞の診断となり，腹腔鏡下修復術を施行した．回腸末端から上行結腸，肝右葉，大網が右胸腔内に脱出しており，これらを還納したところ，右横隔膜の背外側に6×5cm大のヘルニア門を認めたため，右側Bochdalek孔ヘルニアと診断した．横隔膜欠損部は直接縫合閉鎖にて修復した．術後経過は良好であった．近年，成人左側Bochdalek孔ヘルニアに対する完全内視鏡下手術は複数報告されているが，成人右側Bochdalek孔ヘルニアでは，自験例が本邦において初めてであるため，文献的考察を加えて報告する．

　A 70-year-old woman presented with right lateral abdominal pain and emesis. She was diagnosed with an intestinal obstruction caused by a right-sided diaphragmatic hernia. Laparoscopic repair was performed. The terminal ileum, ascending colon, right lobe of the liver and omentum herniated into the thoracic cavity through a defect in the right diaphragm. The organs were drawn back into the abdominal cavity, and a 6×5cm defect was revealed in the dorsolateral portion of the right diaphragm, which is defined as a right-sided Bochdalek hernia. The defect was repaired by direct suture closure. There have been recent reports of endoscopic surgery for adult left-sided Bochdalek hernia; however, this is the first report of laparoscopic repair for adult right-sided Bochdalek hernia in Japan.