腹腔鏡下に横隔膜欠損孔を縫合閉鎖した外傷性肋間ヘルニアの1例

A case of traumatic intercostal hernia treated by laparoscopic direct sutures

◆要旨：患者は53歳，女性．意識消失して転倒し，床に立ててあった一升瓶の注ぎ口に左側腹部を打ちつけ，当院に救急搬送された．左側腹部に径5cm大の発赤と膨隆を認めた．CTで外傷性肋間ヘルニアを認めた．シネCTで呼吸性移動を確認すると，大網が横隔膜と胸腔を経由している外傷性肋間ヘルニアと診断できた．腹腔鏡下に観察すると横隔膜欠損孔をヘルニア門として大網が嵌頓しており，横隔膜欠損孔は腹腔鏡下に直接縫合閉鎖した．術後10か月，合併症やヘルニアの再発なく経過している．稀な受傷機転で発症した，横隔膜を経由した外傷性肋間ヘルニアの1例を経験した．シネCTは損傷部位の正確な診断と術式選択に有益であった．

　A 53-year-old woman was transferred to the emergency department following trauma to the left abdomen which was caused when she had lost consciousness and had fallen on top of the mouth of a 1.8 liter bottle. The trauma site was red and swollen, measuring 5-cm diameter. Traumatic intercostal hernia was revealed by CT scan. Cine CT scan showed the greater omentum prolapsing through the left diaphragm and thoracic cavity into the intercostal space. The diagnosis of traumatic transdiaphragmatic intercostal hernia was made. Laparoscopic finding showed incarceration of greater omentum through the defect of the left diaphragm. The orifice was closed using laparoscopic direct suture without any prosthesis. The patient is well without any complication or hernia recurrence, 10 months after surgery. We experienced an extremely rare case of transdiaphragmatic traumatic intercostal hernia. The cine CT scan was beneficial in identifying and diagnosing the traumatic site accurately and helping determine the surgical procedure.