両側鼠径ヘルニアに対する腹腔鏡手術中に診断された男性の両側不顕性閉鎖孔ヘルニアの1例

A case of bilateral asymptomatic obturator hernia in a male patient diagnosed during laparoscopic surgery for bilateral inguinal hernia

◆要旨：症例は82歳，男性．立位での左鼠径部膨隆を主訴に来院した．左鼠径部に4〜5cm大の膨隆と右鼠径部にも2〜3cm大の膨隆を認めた．両側鼠径部ヘルニアの診断で腹腔鏡下ヘルニア修復術を施行した．術中に両側外鼠径ヘルニアに加えて，右大腿ヘルニアおよび両側閉鎖孔ヘルニアの併存を認めたため，すべてをメッシュで被覆し手術を終了した．男性の閉鎖孔ヘルニアは非常に稀であり，両側例の報告はさらに少ない．本邦における男性閉鎖孔ヘルニアの臨床的特徴について検討し，特に不顕性閉鎖孔ヘルニアに対するマネジメントについて，文献的考察を加えて報告する．

　An 82-year-old man visited our hospital complaining of left inguinal swelling while standing. A bulge measuring 4-5cm and2-3cm were noted on the left and right inguinal regions, respectively. Preoperative diagnosis of bilateral groin hernia was made and laparoscopic surgery by transabdominal preperitoneal repair（TAPP）method was performed. Operative findings clearly revealed right femoral and bilateral obturator hernia in addition to bilateral indirect inguinal hernia. The mesh repair for all the detected hernia was performed. Obturator hernia in male is rare compared to that in female. Moreover, reported cases of bilateral obturator hernia are even few. On the other hand, it is expected that more asymptomatic obturator hernia will be detected with the spread of laparoscopic surgery for inguinal hernia repair. We herein describe the clinical features of obturator hernia in male, especially presenting the management for asymptomatic obturator hernia, with literature review.