腹腔鏡下胃全摘Roux-en-Y再建術後にPetersen's defectのsupracolic componentをヘルニア門とし内ヘルニアをきたした1例

A case of internal hernia with a hernial orifice in the supracolic component of Petersen's defect after laparoscopic total gastrectomy with Roux-en-Y reconstruction

◆要旨：胃癌に対する腹腔鏡下胃全摘Roux-en-Y法再建術時，非吸収糸で間膜間隙を閉鎖したにもかかわらず，術後内ヘルニアを合併した症例を経験した．患者は71歳，男性．2か月前に腹腔鏡下胃全摘Roux-en-Y法再建を施行した．腹痛の精査で横行結腸の内ヘルニアを認め緊急手術を施行した．ヘルニア門は挙上空腸の背側，横行結腸頭側に位置しており，腹腔鏡下に嵌入腸管を整復しヘルニア門を縫合閉鎖した．近年，好発部位に対する非吸収糸での間隙閉鎖により胃癌術後の内ヘルニアは低減しているが，それ以外の部位での発症は稀に起こりうる．術後の腹痛を認めた場合は，間膜間隙閉鎖の有無にかかわらず内ヘルニアを疑う必要がある．

　This paper reports a case of complication of postoperative internal hernia after laparoscopic total gastrectomy with Roux-en-Y reconstruction for gastric cancer. The internal hernia developed despite closure of the mesenteric gap with a non-absorbable suture. The patient was a 71-year-old man. Two months prior, he underwent laparoscopic total gastrectomy with Roux-en-Y reconstruction. In a detailed examination for abdominal pain, an internal hernia was found in the transverse colon, so an emergency surgery was performed. The hernial orifice was located on the dorsal side of the lifted jejunum and on the cranial side of the transverse colon. The incarcerated intestinal tract was repaired laparoscopically, and the hernial orifice was sutured and closed. In recent years, as hernia gaps in common sites are closed with non-absorbable sutures, the number of cases of postoperative hernia after gastric cancer surgery is declining. However, rare cases of hernia of this kind may still be observed. If postoperative abdominal pain is observed after laparoscopic gastrectomy, internal hernia should be considered regardless of whether the mesenteric gap was closed or not.