腹腔鏡下に治療し得た子宮広間膜裂孔ヘルニアの1例

A Case of Small Bowel Herniation through a Defect of the Broad Ligament which was Successfully Repaired by Laparoscopic Surgery

　腹腔鏡下に治療し得た子宮広間膜裂孔ヘルニアを経験したので報告する．症例は54歳，女性で，突然の下腹部痛を主訴に来院した．18歳時に虫垂切除術を受けている．腹部単純X線写真にてniveauを認め，イレウスの診断にて入院となった．イレウスチューブによる保存的治療を試みたが軽快せず，小腸造影にて索状物による腸管の絞扼が疑われ，腹腔鏡によるイレウス解除術を施行した．原因は，左側子宮広間膜異常裂孔への回腸の嵌頓ヘルニアであった．腹腔鏡下に腸管嵌頓を整復したのち，ヘルニア門を縫合閉鎖した．腸切除は行わなかった．子宮広間膜裂孔ヘルニアは非常に稀な疾患であり，これまでに腹腔鏡下手術による報告例はないので，文献的考察を加え報告した．

A case of internal herniation through a defect of the broad ligament of uterus was reported. The patient was a 54-year-old female who developed acute pain on the lower abdomen. An abdominal X-ray revealed small intestinal gases and air-fluid level of the lower abdominal region. She underwent naso-intestinal tube drainage but her condition did not improve. Laparoscopic exploration revealed that the middle part of ileum was incarcerated in a small hole of left broad ligament. The incarcerated ileal loop was successfully brought out by careful traction. Bowel resection was not needed.