腹腔鏡下に整復し一期的に単孔式TEP法に準じて修復を行った鼠径ヘルニア偽還納の1例

A case of false reduction of an inguinal hernia treated with single-incisional totally extraperitoneal repair

◆要旨：症例は70歳，男性．右鼠径部膨隆と疼痛を主訴に当院を受診した．鼠径ヘルニア嵌頓の診断で用手還納したが，腸閉塞を発症していたため同日入院となった．入院後も腸閉塞の改善が乏しく，第6病日に手術を施行した．腹腔鏡下に観察したところヘルニア門は腹腔内に滑脱し，ヘルニアは偽還納となっていた．嵌頓を解除した後に，一期的にTEP法に準じてヘルニア修復を施行した．鼠径ヘルニア偽還納は稀な病態だが，用手還納後に腸閉塞が解除しない症例では，本症を鑑別として考慮する必要がある．また偽還納のような病態でも，腹腔鏡手術は腹腔内の詳細な観察と確実な診断が可能であり，有用である．またTEP法は腸管拡張による影響を受けにくいため，腸閉塞時にも有用な術式である．

　A 70-year-old man was admitted to our hospital with the chief complaint of a bulge and pain in the right inguinal region. He was later diagnosed with an incarcerated right inguinal hernia. Hernial reduction was attempted and appeared to be successful. The patient was subsequently hospitalized for observation. Six days later, the bulge in the right inguinal region recurred and the ileus remained. Therefore, we performed single-incisional laparoscopic totally extraperitoneal repair （TEP） after the incarcerated hernia had reduced. A false reduction of inguinal hernia is rare; however, the possibility of this type of hernia should be considered. Laparoscopic surgery is useful as it can be used for allows observation observe from the inside the abdominal cavity to consequently perform TEP under bowel dilatation.