左傍十二指腸ヘルニア術後の早期再発に対して腹腔鏡下大網充塡を施行した1例

A case of laparoscopic omentoplasty for early recurrence of left paraduodenal hernia

◆要旨：症例は79歳，女性．突然の腹痛で受診した．造影CT検査で左傍十二指腸ヘルニアを疑ったため同日緊急手術とした．腹腔鏡下にヘルニア門を3-0吸収糸で閉鎖し手術終了とした．術後6日目に再度腹痛が出現し，造影CT検査で左傍十二指腸ヘルニアの再発と空腸起始部の十二指腸の通過障害を認めたため，腹腔鏡下にヘルニア囊へ大網充塡を行った．その後の経過は良好で再発は認めていない．左傍十二指腸ヘルニアは比較的稀な疾患であり，腹腔鏡手術を施行した報告は散見されるが，左傍十二指腸ヘルニア術後再発の治療報告は本邦ではなく，文献的考察を踏まえて報告する．

　A 79-year-old woman came to our hospital because of sudden abdominal pain. Contrast-enhanced CT scan revealed a left paraduodenal hernia, and she underwent emergency laparoscopic surgery on the same day. The hernia orifice was closed by 3-0 absorbable suture. Six days after surgery, abdominal pain appeared again, and contrast-enhanced CT scan showed a recurrence of left paraduodenal hernia and obstruction of duodenum. The patient underwent laparoscopic hernia repair with omentoplasty into the hernia sac. Postoperative course was uneventful with no recurrence. Left paraduodenal hernia is relatively rare with few reported cases that were treated by laparoscopic surgery. We report a rare case of recurrent left paraduodenal hernia with literature review.