受傷当日に緊急で腹腔鏡下修復術を行った外傷性腹壁ヘルニアの1例

Laparoscopic surgery for traumatic abdominal wall hernia : A case report

◆要旨：外傷性腹壁ヘルニア嵌頓に対して緊急腹腔鏡下修復術を行った1例を経験したので報告する．患者は63歳，男性．高さ1mの脚立から落下し，地面に立てられた鉄パイプで左側胸部を打撲した．来院時，左側胸部に打撲痕と5cm大の膨隆を認め，腹部造影CT検査で内外腹斜筋，腹横筋筋膜が断裂しており，皮下に小腸が脱出していた．外傷性腹壁ヘルニア・小腸嵌頓と診断し緊急手術を行った．腹腔鏡で観察したところ，腹腔内臓器に明らかな損傷は認めなかった．左上腹部に腹壁筋の断裂を認め，腹腔鏡下に各々を縫合して修復した．腹腔鏡下手術は腹部鈍的外傷において臓器損傷の検索と同時に修復術を行うことができ有用であると考えられた．

　Traumatic abdominal wall hernia （TAWH） is a rare injury and only few cases have been reported that was treated by laparoscopic surgery. We report a patient with TAWH who underwent emergency laparoscopic repair just after the fall accident. A 63-year-old man had fallen off from a 1-meter-high stepladder and hit his left upper abdomen with an iron pipe. Immediately he noticed the bulging of the injured site with local pain and was transferred to the emergency department in our hospital. The abdominal computed tomography revealed disruptions of the muscles of the left upper abdomen and a part of ileum herniated in the subcutaneous space through the muscular defect. The emergency laparoscopy revealed incarceration of the small bowel. Reduction of the hernia and repair of the muscular defect were performed laparoscopically by suturing the muscles layer to layer and the peritoneum. The patient recovered uneventfully and was discharged on postoperative day 13. The emergency laparoscopic surgery for TAWH was feasible and useful for both therapeutic modalities and diagnostic measures to investigate the associated intraabdominal injury.