腹腔鏡補助下横行結腸切除術後の腸間膜欠損部をヘルニア門とした内ヘルニアの1例

A case of internal hernia through mesenteric defect after laparoscopy-assisted transverse colectomy

◆要旨：症例は75歳，男性．横行結腸癌に対して腹腔鏡補助下横行結腸切除術を施行し，腸間膜欠損部は未処置とした．術後42日目に腸間膜欠損部をヘルニア門とした内ヘルニアに対して再手術を施行した．腹腔鏡下でのヘルニア門修復は困難と判断し開腹手術へ移行した．ヘルニア門は約5cm×10cmであり，直接縫合閉鎖が困難であったため空腸をヘルニア門に縫い付けることでヘルニア門を閉鎖した．術後内ヘルニアを予防するために初回手術時に間膜欠損部を縫合閉鎖するかどうかは施設により異なる．横行結腸癌に対する腹腔鏡下術後に内ヘルニアを合併した自験例と本邦報告11例の詳細とともに文献的考察を加えて報告する．

　A 75-year-old man underwent laparoscopy-assisted transverse colectomy for transverse colon cancer, and the mesenteric defect was untouched. On the 42nd postoperative day, reoperation was performed because of an internal hernia associated with the mesenteric defect. Laparoscopic repair of the hernia orifice was judged to be difficult, so we switched to open surgery. The hernia orifice was approximately 5cm×10cm in size, and it was difficult to suture the hernia orifice directly. Therefore, the hernia orifice was closed by suturing the jejunum to the hernia orifice. Whether or not to close the mesenteric defect at the time of the initial surgery to prevent postoperative internal hernia depends on the institution. We report the details of our case that developed postoperative internal hernia after laparoscopic colectomy for transverse colon cancer, with literature review.