腹腔鏡下肝囊胞天蓋切除術後に発生した横隔膜ヘルニアの1例

A case of diaphragmatic hernia after laparoscopic hepatic cyst fenestration

◆要旨：患者は62歳，女性．他院にて1年前に肝右葉巨大肝囊胞に対し腹腔鏡下肝囊胞天蓋切除術を施行された既往がある．腹痛を認め，当院救急外来を受診した．腹部CT検査で右側横行結腸と大網が右横隔膜を通して胸腔内に脱出しており，横隔膜ヘルニアと診断した．腹腔鏡下に脱出した腸管と大網を腹腔内に還納し，直接縫合によるヘルニア修復術を施行した．術後経過は良好であった．

　The patient was a 62-year-old woman who underwent laparoscopic hepatic cyst fenestration for a gigantic hepatic cyst of the right lobe of the liver. One year after surgery, abdominal pain appeared and by abdominal CT scan, she was diagnosed with having a diaphragmatic hernia, which incarcerated the transverse colon and the omentum into the thoracic cavity through the right diaphragm. The intestinal tract and the omentum were pulled back into the abdominal cavity by laparoscope. As the hernia orifice showed the presence of the right diaphragm, laparoscopic diaphragmatic hernia repair was performed with direct closure. The postoperative course was uneventful.