腹腔鏡下に手術を行ったWinslow孔胆囊ヘルニアの1例

Winslow's foramen gallbladder hernia treated with laparoscopic surgery : A case report

◆要旨：症例は91歳，女性．発熱を認め，当院を紹介受診し，急性胆囊炎と診断され入院となった．入院後の画像検査でWinslow孔胆囊ヘルニアと診断され，腹腔鏡下に緊急手術を施行した．腹腔鏡で観察したところ，胆囊全体がWinslow孔に嵌入していた．左腹部に2本，右腹部に1本のポートを置き，小網を切開し胆囊を整復した．その後，アメリカンスタイルとなるようポートを追加し，胆囊を摘出した．Winslow孔ヘルニアでは，小腸が嵌入することが多く，次いで，回盲部，横行結腸の順に多い．胆囊が嵌入することは非常に稀である．適切なポートの追加や配置の工夫により腹腔鏡下に手術を完遂しうる可能性が示唆された．

　A 91-year-old woman was referred to our hospital after developing a fever. She was diagnosed with acute cholecystitis and was admitted. Imaging tests after admission yielded a diagnosis of Winslow's foramen gallbladder hernia, which prompted us to perform an emergency laparoscopic surgery. Laparoscopic observation revealed that the entire gallbladder herniated into the foramen of Winslow. Two ports were placed in the left abdomen and one in the right abdomen. An incision was made into the lesser omentum, and the gallbladder within the omental sac was repositioned. Subsequently, ports were added to achieve an American-style setting, and the gallbladder was removed. Hernia of the foramen of Winslow commonly involves the herniation of the small intestine, followed by the cecum and transverse colon. Herniation of the gallbladder is very rare. It was demonstrated that surgery could be completed laparoscopically with the addition and placement of appropriate ports.