二期的腹腔鏡下ヘルニア修復術が有用であったDe Garengeot herniaの1例

Two-stage laparoscopic hernia repair for De Garengeot hernia : A case report

◆要旨：症例は53歳男性．3日前から持続する右鼠径部痛と腫脹を自覚し，症状増悪のため近医を受診．右鼠径部ヘルニア嵌頓が疑われ当科を紹介受診した．腹部超音波検査，腹部CTで右大腿ヘルニア虫垂嵌頓（De Garengeot hernia）と診断し，緊急手術を施行した．嵌頓した虫垂に炎症所見と周囲腹水を認め，メッシュを留置した際の感染リスクを考慮し，腹腔鏡下虫垂切除と嵌頓腹膜の翻転結紮を施行した．術後28日目に待機的にヘルニア修復をTAPP（transabdominal preperitoneal repair）法にて行った．二期的腹腔鏡下ヘルニア修復術は，De Garengeot herniaの治療において，メッシュ感染や根治性の点で有用な治療選択肢と考えられたため報告する．

　A 53-year-old man presented with right inguinal pain and swelling that had persisted for 3 days and visited a nearby physician with worsening symptoms. An inguinal hernia was suspected to be incarcerated, and he was referred to our hospital. Abdominal ultrasonography and abdominal computed tomography revealed an incarcerated appendix in the right femoral hernia （De Garengeot hernia）, and emergency laparoscopic surgery was performed. Inflammation and ascites were observed around the incarcerated appendix. Laparoscopic appendectomy was performed, and the hernia sac was reflected and ligated out of consideration for mesh-related complications. On the 28th day after the first surgery, transabdominal preperitoneal repair was performed. As shown in this case, two-stage laparoscopic hernia repair is considered to be a useful treatment option in terms of mesh infection and curability for De Garengeot hernia.