術前CTにて診断し腹腔鏡下に修復した横行結腸間膜ヘルニアの1例

A case of transverse mesocolon hernia diagnosed by preoperative CT and treated by laparoscopic surgery

◆要旨：患者は64歳，女性．虫垂切除術の開腹歴があった．上腹部痛と嘔吐を主訴に当院を受診した．腹部造影CTにて横行結腸間膜ヘルニアによる内ヘルニアと診断し，同日緊急手術を施行した．腹腔鏡下に観察すると，Treitz靱帯左側の横行結腸間膜にヘルニア門を認め，空腸の嵌入を認めた．ヘルニア内容である空腸をヘルニア囊外へ引き出し，ヘルニア門を切開開放した．ヘルニア囊を形成する横行結腸間膜は平坦となり，腸管の再嵌入は起こらないと判断し，縫合閉鎖は不要とした．経過良好で術後7日目に退院となった．今回，比較的稀な横行結腸間膜ヘルニアに対し，術前に診断し腹腔鏡下腸閉塞解除術を施行した症例を経験したので報告する．

　The patient was a 64-year-old woman with a history of appendectomy by laparotomy. She presented to our hospital with upper abdominal pain and vomiting. She was diagnosed as having an internal hernia from transverse mesocolon hernia on contrast-enhanced abdominal computed tomography （CT） ; emergency surgery was performed on the same day. On laparoscopic observation, the hernia orifice was seen in the transverse mesocolon to the left of ligament of Treitz. The jejunum was invaginated and it was pulled out of the hernia sac. The hernia orifice was cut open and the transverse mesocolon forming the hernia sac became flat. Since we considered that the intestinal invagination will no longer occur, suture closure was not performed. The patient's course was uneventful, and she was discharged from the hospital on postoperative day 7. We report a relatively rare case of transverse mesocolon hernia which was diagnosed preoperatively and was treated by laparoscopic surgery.