CT画像の変化を観察しえたWinslow孔ヘルニアに対して腹腔鏡下手術を施行した1例

A case of herniation through foramen of Winslow followed by CT scan imaging changes and treated with laparoscopic surgery

◆要旨：症例は54歳，男性．右上腹部痛のため当院を受診し，急性胃腸炎の診断で帰宅経過観察となった．帰宅後も症状の改善を認めず，8時間後に再来院となった．腹部造影CTにて小網内の拡張した小腸とその腸間膜がWinslow孔に収束する所見を認め，Winslow孔ヘルニアと診断し，緊急で腹腔鏡下手術を施行した．嵌入小腸はうっ血を認めたが整復後に色調の改善を認め，小腸切除は行わずに済んだ．術後経過は良好で術後11日目に退院となった．Winslow孔ヘルニアは稀な疾患であるが，特徴的なCT所見により早期診断が可能であり，早期治療を行うことで腸管の拡張による視野不良や虚血の頻度が低下し腹腔鏡下手術が可能と考えられた．

　A 54-year-old man was examined at our hospital because of right upper quadrant pain, and was diagnosed with acute gastroenteritis. He was then followed up after returning home. After returning home, he did not notice any improvement in his symptoms, and he returned to the hospital eight hours later. Abdominal contrast-enhanced CT showed dilated small intestine in the lesser omentum and convergence of the mesentery into the foramen of Winslow, therefore we made a diagnosis of herniation through the foramen of Winslow（HFW）, and performed emergency laparoscopic surgery. The invaginated small intestine showed congestion, but after the reduction, the color improved, and the small intestine resection was not performed. The postoperative course was good and he was discharged from the hospital on the 11th day after surgery. HFW is a rare disease, but early diagnosis is possible by characteristic CT findings, and it was considered that early treatment reduced the frequency of poor visual field and ischemia due to dilation of the bowel, making laparoscopic surgery possible.