TEP法により修復した水腎症を伴った鼠径部尿管ヘルニアの1例

A case of ureteroinguinal hernia with hydronephrosis treated by totally extraperitoneal hernia repair

◆要旨：鼠径部尿管ヘルニアは鼠径管内に尿管が脱出する稀な病態である．患者は70代，男性．過去に右鼠径ヘルニアに対してヘルニア修復術を施行されており，術後右鼠径部の再膨隆を自覚，増大傾向にあるため当院を受診した．CT検査で右鼠径部からの小腸・尿管の脱出，右水腎水尿管症を認め，右鼠径部尿管ヘルニアの診断で，右尿管ステント挿入，審査腹腔鏡後にtotally extraperitoneal hernia repair（以下，TEP）法による鼠径ヘルニア修復術を施行した．術後，ヘルニア再発なく経過している．本邦において成人の鼠径部尿管ヘルニアのTEP法による手術治療例の報告はなく，文献的考察を加えて報告する．

　Ureteroinguinal hernia is a rare condition with the ureter herniated in the inguinal canal. A 70-year-old male, who had undegone right inguinal hernia repair twice, had a recurrence of the inguinal hernia immediately after the last repair. He was referred to our hospital due to the still ongoing bulge on the repaired side. CT scan showed small intestine and right ureter herniated in the right inguinal canal along with the sign of right hydronephrosis. Therefore, he was diagnosed with the right ureteroinguinal hernia. Right ureteral stenting and diagnostic laparoscopy followed by totally extraperitoneal hernia repair （TEP） was conducted. No recurrence is seen during follow-up. Here we report a case of ureteroinguinal hernia, successfully treated with TEP.