メッシュプラグのS状結腸穿通による腹壁膿瘍に対し腹腔鏡手術を施行した1例

A case of laparoscopic surgery for abdominal wall abscess caused by penetration of the sigmoid colon by a mesh plug

◆要旨：症例は73歳，男性．22年前にメッシュプラグを用いたヘルニア根治術が施行されていた．左鼠径部の痛みと腫脹を訴え，精査目的に行ったCTや下部消化管内視鏡にてメッシュプラグによるS状結腸穿通，腹壁膿瘍の診断となり手術の方針となった．手術では腹腔鏡操作と鼠径部からの前方アプローチにてメッシュプラグを含んだS状結腸を腹壁から離断した．その後，鏡視下にS状結腸を脱転し，メッシュプラグを含んだS状結腸を部分切除した．ヘルニア手術で使用されるメッシュの腸管への穿通はしばしば報告されている．このような症例に対し，腹腔鏡手術は骨盤壁の解剖を拡大視でき，異物を含んだ腸管を腹壁から安全に剝離することが可能と考えられた．

　The patient was a 73-year-old man. Twenty-four years previously, he had undergone laparoscopic hernioplasty for bilateral inguinal hernia. Two years later, recurrence was observed on the left side, and hernioplasty using a mesh-plug was performed. At his current presentation, he visited our hospital complaining of pain and swelling in the left groin. Computed tomography （CT） revealed an inflammatory mass and abdominal wall abscess continuous with the sigmoid colon in the left groin, and colonoscopy revealed a mesh-plug exposed in the sigmoid colon. Taken together, we considered that the mesh plug had caused sigmoid colon perforation and abdominal wall abscess, and surgery was planned. In the operation, the sigmoid colon containing the mesh-plug was resected from the abdominal wall in a laparoscopic operation with an anterior approach from the groin. Then, partial resection of the sigmoid colon containing the mesh-plug was performed. Cases involving penetration of the intestine by the mesh used in hernia surgery have been often reported. In such cases, it is considered that laparoscopic surgery can magnify the pelvic wall anatomy and safely detach the intestinal tract containing the foreign body from the abdominal wall.