CT検査で術前診断し腹腔鏡下に手術を施行したWinslow孔ヘルニアの1例

A case of herniation through foramen of Winslow diagnosed preoperatively by CT scan and treated with laparoscopic surgery

◆要旨：患者は85歳，女性．来院6時間前に突然発症した腹痛を主訴に当院を受診した．腹部造影CT検査で網囊内に拡張した小腸と，門脈背側に小腸間膜を認めた．Winslow孔ヘルニアと診断し，腹腔鏡下に緊急手術を行った．腹腔鏡で観察すると，術前診断通り，Winslow孔に小腸が陥入していた．腹腔鏡下に陥入した50cm程度の小腸を整復した．小腸に損傷，虚血はなく，小腸の切除は施行しなかった．術後経過は良好で，術後9日目に退院となった．Winslow孔ヘルニアは稀な疾患ではあるが，特徴的なCT所見を示し，術前診断は可能である．発症早期の症例や，術前に腸管の減圧が可能な症例には腹腔鏡下手術が有用であると考えられた．

　An 85-year-old woman was seen in the emergency department of our hospital with a 6-hour history of abdominal pain. An abdominal CT scan showed a dilated small intestine in the omental bursa and herniation of mesentery behind the portal vein. Under the diagnosis of herniation through the foramen of Winslow, we performed emergency laparoscopic surgery. We found that approximately 50cm of dilated small intestine was herniated through the foramen of Winslow into the omental bursa and released the incarceration under laparoscopy. Intestinal resection was unnecessary because incarcerated intestine had no damage or ischemic change. She recovered well and was discharged on postoperative day 9. Herniation through the foramen of Winslow is very rare, but it is possible to diagnose this herniation preoperatively because of characteristic findings on abdominal CT images. Laparoscopic approach for this herniation is useful if an emergency operation can be performed at early stage or the bowel can be decompressed before operation.