腹膜外腔到達法による腹腔鏡下鼠径ヘルニア修復術後に発症した吸収性体内固定用組織ステープルによる腸閉塞の1例

A case of intestinal obstruction due to a bioabsorbable staple following laparoscopic total extraperitoneal repair of inguinal hernia

◆要旨：患者は72歳，男性．両側内鼠径ヘルニアに対する腹膜外腔到達法による腹腔鏡下鼠径ヘルニア修復術の12日後に，腹痛と嘔吐が出現し腹部造影CTで右下腹部に狭窄部位を伴う小腸の拡張を認めた．癒着性腸閉塞と診断して手術を施行し，ステープルにより小腸が癒着していたためステープルを除去して通過障害を解除した．腹膜外腔到達法による腹腔鏡下鼠径ヘルニア修復術後の腸閉塞は少ないが，自験例は脱落したステープルが腹腔内に迷入して小腸の癒着を併発した稀な症例である．

　The patient was a 72-year-old man. He presented with abdominal pain and vomiting 12 days after laparoscopic total extraperitoneal repair of bilateral internal inguinal hernias. An abdominal contrast CT revealed small intestinal distension due to stenosis in the right lower abdominal area. Diagnosed with adhesive intestinal obstruction, surgery was performed, and the small intestine was discovered to have adhered due to the staple. The staple was removed, and the narrowing resolved. Intestinal obstruction after abdominal cavity inguinal hernia repair is uncommon. We experienced a rare case where a surgical staple fell out and wandered into the peritoneal cavity causing adhesion of the small intestine.