遅発性外傷性右横隔膜ヘルニアに対し腹腔鏡下手術を施行した1例

A case of delayed traumatic right diaphragmatic hernia repaired by laparoscopic approach

◆要旨：患者は64歳，男性．腹痛を主訴に来院した．右横隔膜ヘルニアを認め，5年前に転落による右肋骨骨折の既往があることから，遅発性外傷性右横隔膜ヘルニアと診断し腹腔鏡下手術を施行した．陥入していた小腸は一部壊死しており，腹腔鏡下に還納の後，小開腹創より体外へ挙上し小腸切除を施行した．ヘルニア門の修復は腹腔鏡下に非吸収糸の連続縫合で行った．術後経過は良好で9日目に退院した．術後3か月で他疾病に対し腹腔鏡下手術を施行した際に腹腔内を観察すると，肝臓がヘルニア門を被覆しており，再発は認めなかった．

　A 64-year-old man presented to the hospital with a chief complaint of abdominal pain. Examination revealed a right diaphragmatic hernia and a history of right rib fracture from a fall 5 years earlier. The patient was consequently diagnosed with delayed traumatic right diaphragmatic hernia and subsequently underwent laparoscopic surgery, which revealed partial necrosis of the invaginated small intestine. After laparoscopic reduction, the small intestine was lifted out of the body through a small incision for resection. The hernial opening was laparoscopically repaired with continuous suturing using non-absorbable sutures. Postoperative progress was uneventful and the patient was discharged on day 9. At 3 months postoperatively, laparoscopic examination of the abdominal cavity to treat a different condition showed that the hernia orifice was covered by the liver and there was no evidence of recurrence.