腹腔鏡下に修復した大坐骨孔ヘルニアの1例

A case of sciatic hernia repair using laparoscopic approach

◆要旨：患者は77歳，女性．右臀部から大腿部にかけての疼痛があり，近医整形外科の腹部CT検査で右股関節背側の軟部腫瘍を疑われ，当院を紹介され受診した．腹部CT検査にて右大坐骨孔より脱出する小腸を認め，大坐骨孔ヘルニアと診断した．腸閉塞症状は認めなかったが，疼痛が持続するため，待機的に手術の方針とした．手術は腹腔鏡下に行い，メッシュを用いて修復を行った．術後経過は良好で，右臀部から大腿部の疼痛は消失し，現在まで3か月再発所見なく経過している．坐骨孔ヘルニアは骨盤底ヘルニアの中でも稀な疾患である．腹腔鏡下手術による修復の報告例は非常に少なく，文献的考察を加えて報告する．

　A 77-year-old woman was referred to our hospital owing to complaints of pain extending from the right buttock to the dorsal femoral side. Abdominal computed tomography revealed a soft tissue shadow at the back of the right hip joint, which was diagnosed as sciatic hernia with the small intestine suspected to protrude through the right greater sciatic foramen. Her symptoms were not resolved spontaneously. An elective laparoscopic surgery was performed to repair hernia using a mesh. Her postoperative course was uneventful. Her symptoms disappeared and did not recur for 3 months postoperatively. Sciatic hernias rarely occur, and its successful laparoscopic repair has not been frequently described. Here we report this case and discuss sciatic hernias with a literature review.