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◆要旨:患者は38歳,女性.36歳時に胆囊炎に対して腹腔鏡下胆囊摘出術が行われた.また,3回の帝王切開の既往がある.最終帝王切開1週間後より上腹部の膨隆と疼痛が出現したため当院産婦人科を受診し,当初腹壁瘢痕ヘルニアが疑われたため当科紹介となった.腹部造影CTで計測した臍部での腹直筋間距離は40.7mmであり,分娩後の腹直筋離開の可能性があると考えられたが,胆囊摘出術時の臍部ポート孔部に生じた腹壁瘢痕ヘルニアの可能性もあり,疼痛も伴っていたことから手術適応とした.手術は腹腔鏡下に行い,腹腔鏡下腹壁瘢痕ヘルニア修復術(intraperitoneal onlay mesh : IPOM)に腹壁縫合を加えたIPOM plus法に準じて行った.術後経過は良好で,術後5日目に退院となった.妊娠・出産に伴う腹直筋離開は,本邦では手術適応とされることは少ないが,離開の程度が高度な場合や有症状の症例では腹腔鏡下修復術が有用である.
A 38-year-old woman underwent laparoscopic cholecystectomy for cholecystitis at 37 years of age. She had a history of three cesarean deliveries. She developed upper abdominal pain and swelling a week after the last cesarean delivery and presented to our department for suspected abdominal wall scar hernia. The distance between the rectus abdominis muscles on computed tomography was 40.7 mm at the umbilicus. Although we suspected diastasis recti, we performed surgery because the patient complained of pain, and an abdominal wall incisional hernia could not be ruled out. We performed laparoscopic intraperitoneal onlay mesh (IPOM) repair with fascial closure (IPOM-plus). She developed pain postoperatively; however, she could be discharged on the 5th postoperative day. Despite persistent abdominal distention, we could improve the shape of the body to some extent using a minimally invasive procedure similar to IPOM-plus.
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