成人の停留精巣を伴う鼠径ヘルニアに対して二期的腹腔鏡下手術を行った1例

A case of adult inguinal hernia with cryptorchidism treated by two-stage laparoscopic surgery

◆要旨：症例は58歳，男性．左鼠径部の膨隆と疼痛にて救急搬送された．左鼠径ヘルニア嵌頓の診断で用手還納を行った後に，腹腔鏡下ヘルニア修復術の腹腔内到達法にて緊急手術を施行した．左内鼠径輪の開大を認め，メッシュにてヘルニア修復術を施行した．右内鼠径輪も開大しており，その内側の腹腔内に停留精巣を認めた．精巣をヘルニア囊内に戻し腹膜を縫合閉鎖した．術後経過は問題なく，術後5日目に退院となった．精巣摘出を承諾したため，2か月後に泌尿器科医と合同で腹腔鏡下に精巣摘出ならびにヘルニア修復術を施行した．今回，成人における停留精巣を合併した鼠径ヘルニアに対し，二期的腹腔鏡下手術にて治療した1例を経験したので報告する．

　A 58-year-old male patient arrived at our hospital with painful swelling in the left inguinal region. After successful manual reduction with a diagnosis of incarcerated inguinal hernia, an emergency laparoscopic hernia repair procedure（transperitoneal anterior peritoneal repair : TAPP）was performed. Laparoscopy revealed that the hernia sac protruded from the left internal inguinal ring, and mesh repair was performed. At the same time, an intra-abdominal cryptorchidism was found inside the enlarged right internal inguinal ring. The testicle was directed to the hernia sac, and the right internal inguinal ring was closed with simple sutures. The patient consented to removal of the diseased testis. Two months after the initial surgery, a two-stage laparoscopic orchiectomy by a urologist and TAPP were performed. We reported a case of an adult who underwent a two-stage laparoscopic orchiectomy and hernia repair for a cryptorchidism diagnosed at the time of initial TAPP.