術前CT検査にて診断し腹腔鏡下に手術した子宮広間膜裂孔ヘルニアの1例

Laparoscopic surgery of hiatal hernia of broad ligament of the uterus

子宮広間膜裂孔ヘルニアは稀である．術前CT検査にて診断し腹腔鏡下に治療した症例を経験したので報告する．40歳代の女性で突然の右下腹部痛で発症した．CT検査で子宮が腹側左側に偏位し，Douglas窩に拡張した小腸ループが確認できた．右子宮広間膜裂孔ヘルニアと診断し，腹腔鏡下に手術を行った．右子宮広間膜に約2cmの裂孔を認め，これをヘルニア門として回腸が20cm嵌頓していた．嵌頓腸管を整復し，子宮広間膜の裂孔は縫合閉鎖した．腸切除は必要なかった．本症は稀であるが，腸閉塞の鑑別診断として念頭に置き，CT検査で早期に診断することにより腸切除を回避できる．腸切除が不要であれば腹腔鏡下に手術することが第一選択となる．

　Hiatal hernia of the broad ligament of the uterus is rare. We report a patient with diagnosed by preoperative CT scan and who underwent laparoscopic surgery. A 40 year-old woman was referred to our hospital because of sudden right lower abdominal pain. A pelvic CT scan revealed displacement of the uterus toward the left side and existence of a dilated small intestine in Douglas pouch. Diagnosis of intestinal obstruction due to a hiatal hernia of the right broad ligament of the uterus was made and the patient underwent laparoscopic surgery. Operative findings revealed an ileum, approximately 20 cm in length, that incarcerated into a 2 cm-sized fissure of the right broad ligament of the uterus. The ileum was reduced and the orifice was closed. Enterectomy may be avoidable by having this rare disease in mind as a differential diagnosis of ileus, and diagnosing it at an early stage. Moreover, laparoscopic surgery may be performed easily if enterectomy can be avoided.