冠状動脈バイパス術時に発見された心囊内横隔膜ヘルニアの1例

Intrapericardial Diaphragmatic Hernia Discovered During Coronary Artery Bypass Surgery：Report of a Case

はじめに　心囊内横隔膜ヘルニアはまれな疾患で，先天性・外傷性・医原性のものがあり，外傷性の報告が多い．緊急手術例や数十年経過して発見され手術された症例もみられる．手術は開腹・開胸あるいは腹腔鏡下アプローチにより，ヘルニア門の閉鎖が行われている．われわれは冠状動脈バイパス術（CABG）時に発見された心囊内横隔膜ヘルニアを経験したので，文献的考察を含めて報告する．

Intrapericardial diaphragmatic hernia is a rare condition, which can develop due to congenital, traumatic, or medical causes. Traumatic hernia is the most commonly reported hernia in which some cases require emergency treatment due to shock, cardiac tamponade, acute abdomen, or respiratory symptoms, whereas others are discovered and treated after several years or decades. Traumatic hernia is treated using laparotomy, thoracotomy, or laparoscopic approach, and the hernia portal is either closed directly or with a patch. A 76-year-old man was found to have an intrapericardial diaphragmatic hernia during coronary artery bypass surgery. The intrapericardial diaphragmatic hernia was closed using a bovine pericardial patch. The postoperative course was excellent.