大腿部のLittréヘルニア嵌頓に対し腹腔鏡補助下大腿ヘルニア修復術を行った1例

Laparoscopy-assisted femoral hernia repair for incarcerated Littré hernia：A case report

◆要旨：症例は95歳の女性．右鼠径部腫脹を主訴に，当院へ紹介受診となった．理学的および画像所見で小腸の右大腿ヘルニア嵌頓と診断し，緊急手術を腹腔鏡下に開始した．右大腿輪に小腸の脱出を認め整復を試みたが困難であったため，大腿法を併施し裂孔靱帯を切開してヘルニア内容物を還納した．ヘルニア内容物はMeckel憩室であった．大腿部を閉創後，transabdominal preperitoneal approach （以下，TAPP法）でヘルニア門の修復を行ったのちに，腹腔鏡下に憩室切除を行った．術後経過は良好で，術後7日目に退院した．Meckel憩室の大腿ヘルニア（Littréヘルニア）嵌頓に対して大腿法併用の腹腔鏡補助下大腿ヘルニア修復術と憩室切除術を同時に施行した1例を経験したので，文献的考察を加え報告する．

　A 95-year-old woman presented with swelling in the right groin and was diagnosed with an incarcerated right femoral hernia. We performed emergency laparoscopy and found herniation of the small intestine ; however, we could not reduce the hernia. Therefore, we combined the femoral approach with laparoscopy, and the incarcerated small intestine was released by cutting the lacunar ligament. Intraoperatively, we diagnosed a right femoral hernia with an incarcerated Meckel's diverticulum （Littré hernia）. The hernia hilum was repaired with a mesh using a transabdominal preperitoneal approach, and the Meckel's diverticulum was laparoscopically resected. The patient's postoperative course was uneventful, and she was discharged seven days after surgery. Laparoscopic repair combined with a femoral approach may be a useful strategy in patients with incarcerated femoral hernia.