腹腔鏡下に診断，治療しえたS状結腸間膜窩ヘルニアの1例

Successful laparoscopic diagnosis and treatment for small bowel obstruction : a case of intersigmoid hernia

◆要旨：患者は腹部手術歴のない64歳の男性で，下腹部痛で近医を受診し，腸閉塞の診断で当院に紹介された．CT検査および小腸造影X線検査で左下腹部に閉塞機転があると判断し，腹腔鏡下手術を行った．S状結腸間膜の後腹膜付着部に陥凹部を認め，小腸が嵌入していた．S状結腸間膜窩ヘルニアと診断し，嵌入を解除した．嵌入小腸に壊死はなかったため小腸切除はせず，手術を終了した．術後経過は良好であった．S状結腸間膜窩ヘルニアは比較的稀な疾患であり，特徴的なCT所見や小腸造影X線所見が認められる．開腹手術歴のない腸閉塞に対して腹腔鏡下でS状結腸間膜窩ヘルニアと診断，治療しえた．文献的考察を加えて報告する．

　A-64-year-old man with no history of laparotomy presented at a local clinic with lower abdominal pain. He was diagnosed to have a small bowel obstruction （SBO） and was referred to our hospital. Abdominal computed tomography （CT） scan and small intestine contrast study by long tube revealed a stenosis in the left lower abdomen. An exploratory laparoscopic surgery was performed to determine the cause of SBO. Laparoscopy showed that the small intestine had herniated into the intersigmoid fossa. Thus a diagnosis of intersigmoid hernia was made and the incarceration was reduced. Since the incarcerated portion of the small intestine was viable, the small intestine was not resected. The postoperative course was uneventful. Intersigmoid hernia is very rare, and is associated with some characteristic radiological findings. The SBO in our patient who did not have a history of laparotomy, was determined to be an intersigmoid hernia by laparoscopic surgery. We report our experience of successful laparoscopic diagnosis and treatment for intersigmoid hernia along with a literature review.