TEP法を用いて二期的に修復しえたde Garengeot herniaの1例

A case of de Garengeot hernia repaired in two stages using the totally extraperitoneal repair method

◆要旨：症例は75歳，女性．右大腿部の膨隆を主訴に当院を受診した．右大腿部に母指頭大の膨隆を認めた．CTで右大腿ヘルニアへの虫垂の嵌頓を認め，周囲に液貯留を伴っていた．de Garengeot herniaと診断し，感染のリスクを考慮し二期的に手術を行う方針とした．まず緊急で腹腔鏡下虫垂切除術を施行した．経過は良好で，術後2日目に退院した．初回手術後57日目に完全腹膜外修復法（totally extraperitoneal repair：TEP法）で右大腿ヘルニアを修復した．術後経過は良好で，術後2日目に退院した．de Garengeot herniaは非常に稀な疾患であり，一期的手術や二期的手術など様々な報告がある．今回われわれはTEP法により二期的にde Garengeot herniaを修復しえた症例を経験したため報告する．

　A 75-year-old woman presented to our hospital with a complaint of swelling in the right thigh. A 1.5×1.5- cm mass was observed in her right thigh. A computed tomography scan revealed an incarcerated appendix within a right femoral hernia, with surrounding fluid accumulation. She was diagnosed as having a de Garengeot hernia, and considering the risk of infection, we decided upon a staged surgical approach. First, an emergency laparoscopic appendectomy was performed. The postoperative course was favorable, and she was discharged on the second postoperative day. On the 57th day after the initial surgery, the right femoral hernia was repaired using the totally extraperitoneal repair（TEP） method. The postoperative course was also favorable, and the patient was discharged on the second postoperative day. De Garengeot hernia is a very rare condition, and various reports exist regarding both single-stage and staged surgeries. In this report, we present our experience of successfully repairing a de Garengeot hernia using the TEP method in a two-staged approach.