Morgagni孔ヘルニアと食道裂孔ヘルニアの併存例に対し一期的に腹腔鏡下修復術を施行した1例

A case of Morgagni foramen hernia combined with an esophageal hiatal hernia treated by laparoscopic surgery in one stage

◆要旨：症例は78歳，女性．労作時呼吸困難を主訴に当院を受診した．腹部造影CTでMorgagni孔ヘルニアおよび食道裂孔ヘルニアを認め，一期的に腹腔鏡下両ヘルニア修復術を行った．手術は5ポートで行い，Morgagni孔ヘルニアに対しては，ヘルニア囊を可及的に切除した後，ヘルニア門が7cm径と大きかったため，ヘルニアメッシュでの修復を行った．食道裂孔ヘルニアに関しては，ヘルニア門の開大は小さく，直接縫合閉鎖のみとした．Morgagni孔ヘルニアと食道裂孔ヘルニアの併存例は稀であり，同疾患に対する腹腔鏡下アプローチは，脱出臓器の還納やヘルニア囊の観察などが容易であり安全で低侵襲な治療法の一つと考えられた．

　A 78-year-old woman was hospitalized because of dyspnea. Contrast-enhanced CT indicated a Morgagni hernia combined with an esophageal hiatal hernia, and laparoscopic repair for the Morgagni hernia and esophageal hiatal hernia in one stage with 5 ports was performed. The Morgagni hernia, which had an orifice of about 7cm in diameter, was repaired with hernia mesh after hernia sac was resected, partially. The esophageal hiatal hernia was of the sliding type, and its orifice was small, so we repaired it with direct suture. A Morgagni hernia is rare among diaphragmatic hernias, and there are few cases combined with esophageal hiatal hernia. Laparoscopic repair of a Morgagni hernia and esophageal hiatal hernia is a safe and minimally invasive procedure because of its easiness of reduction and observation of hernias.