腹腔鏡下手術を施行した両側閉鎖孔ヘルニアの1例

A case of obturator hernia repaired by laparoscopic operation

◆要旨：患者は79歳，女性．くも膜下出血で脳外科入院中に下腹部痛と嘔吐があり，当科に紹介された．身体所見では腹部膨満と圧痛を認めたが，腹膜刺激症状はなく，Howship-Romberg徴候も認めなかった．腹部CTで恥骨筋と腸腰筋との間に腫瘤陰影を認めたため左閉鎖孔ヘルニア嵌頓と診断し，腹腔鏡下手術を施行した．左閉鎖孔に小腸が嵌頓しており鉗子で腸管を牽引して嵌頓を解除した．ヘルニア囊を反転し，結紮した．右側にも閉鎖孔ヘルニアを認め同様に修復した．術後経過に大きな問題はなかった．

　腹腔鏡下閉鎖孔ヘルニア修復術は低侵襲で有用な術式であると考えられた．

　We report a case of laparoscopic bilateral obturator hernia repair who was preoperatively diagnosed by computed tomography. The patient, a-79-year-old woman, had severe lower abdominal pain and vomiting when she was hospitalized for the treatcment of subarachnoid hemorrhage. On physical examination she had revealed abdominal distension and tenderness, although neither Blumberg nor Howship-Romberg's sign was noted. A computed tomography scan revealed bilateral cystic masses lying deep to the superior pubic ramus and behind the pectineal muscle. The patient underwent laparoscopic surgery under general anesthesia. An incarceration of the small intestine was observed in the left obturator canal, and was reduced by tractioning the intestine. There was no incarceration in the right obturator canal. The hernia sac was turned over internally, and ligated. The postoperative recovery was uneventful. Laparoscopic minimally invasive surgery is an appropriate and reliable treatment for an obturator hernia.