TEP施行時に診断したAmyand's herniaの1例

Amyand's hernia diagnosed during TEP : A case study

◆要旨：症例は63歳，男性．右鼠径部膨隆で当院を受診した．膨隆は立位のみでみられ，臥位では消失していた．右鼠径ヘルニアと診断し，待機的にtotally extraperitoneal preperitoneal mesh repair（TEP）を施行した．術中，内鼠径輪でヘルニア囊を同定し，その周囲を剝離するとヘルニア囊内側に索状物を認めた．精管と判断し，この索状物とヘルニア囊の間を剝離した結果，腹膜を損傷した．腹腔内から観察を行うと索状物は虫垂であり，ヘルニア囊内で癒着していた．TEP施行時にAmyand's herniaと診断した報告例はなく，特徴的術中所見とともにその注意点を報告する．

　A 63 year-old man visited our hospital complaining of swelling of the right inguinal region. The swelling appeared only in the standing position and disappeared in the supine position. He was diagnosed as having a right inguinal hernia and underwent elective laparoscopic totally extraperitoneal preperitoneal mesh repair（TEP）. During surgery, the hernia sac was detected in the internal inguinal ring, and a cord-like substance was found inside the medial hernia sac when the surrounding area was dissected. We determined it to be the vas deferens and separated the cord from the hernia sac, which resulted in damage to the peritoneum. Observation from the abdominal cavity revealed that the cord-like substance was actually the appendix, which was adhered to the hernia sac. There have been no reported cases of Amyand's hernia diagnosed at the time of TEP, so we report the characteristic intraoperative findings and their associated precautions.