腹腔鏡下に修復したS状結腸間膜内ヘルニアの1例

A case of intramesosigmoid hernia treated with laparoscopic surgery

◆要旨：患者は50歳女性で，腹痛と嘔吐を主訴に近医より紹介となった．近医での腹部単純X線検査にて小腸イレウスの診断となった．手術既往歴はなく，腹部造影CT検査では，総腸骨動脈分岐レベルで，腸管の口径差を認めた．イレウス管による保存加療を優先することとした．入院後も排ガス，排便を認めず，腹部単純X線上も改善を認めなかったため入院後3日目に腹腔鏡にて手術を行うこととした．腹腔内を観察するとS状結腸間膜が膨隆し，S状結腸間膜左葉に小腸が陥入しておりS状結腸間膜内ヘルニアの診断に至った．同腸管を引き出し，ヘルニア門を体腔内で縫合閉鎖し手術を終えた．術後経過は良好であり術後8日目に退院となった.

　A 50-year-old woman was admitted with abdominal pain and vomiting; she had no history of abdominal surgery or injury. An abdominal X-ray examination showed multiple niveaus of the small bowel. Abdominal computed tomography revealed a caliber difference in the intestinal tract at the level of the common iliac artery. The symptoms were very mild and a conservative therapy using an ileus tube was performed; however, no symptomatic remission was achieved. Laparoscopic surgery was performed 3 days after admission. Upon laparotomy, it was observed that the ileum was incarcerated through a hole in the left lobe of the sigmoid mesentery. Consequently, the patient underwent a surgical procedure and was diagnosed with an intramesosigmoid hernia. After the incarcerated ileum was reduced, the hernia orifice was sutured and closed. The patient made a satisfactory recovery and was discharged 8 days after operation.