腹腔鏡にて診断しTAPP法を施行した大腿ヘルニアに併存する膀胱ヘルニアの1例

A case of urinary bladder hernia diagnosed during TAPP repair for femoral hernia

◆要旨：患者は91歳の女性で，食欲不振・嘔吐を主訴に受診した．CT・理学的所見から，右大腿ヘルニア嵌頓と診断し，用手還納後にTAPP（transabdominal preperitoneal repair）法を施行した．術中に大腿輪から膀胱の一部が脱出する所見を認め，大腿ヘルニアに伴った膀胱ヘルニアと診断した．一般に，膀胱ヘルニアの診断にはCTが有用と考えられている．しかし術前CTでも膀胱ヘルニアの診断ができないことがあり，腹腔内から観察が可能なTAPP法は有用な術式である．

A 91-year-old female presented with the chief complaints of loss of appetite and vomiting. She was diagnosed with a right femoral incarcerated hernia based on computed tomography （CT） scan and physical examination, for which she underwent manual reduction and transabdominal preperitoneal （TAPP） repair. During surgery, a partial prolapse of the urinary bladder from the femoral ring was observed. Therefore, a diagnosis of urinary bladder hernia accompanying femoral hernia was established. CT scans are generally considered to be useful in the diagnosis of urinary bladder hernias. However, this diagnosis may not be possible based on preoperative CT findings. On the other hand, TAPP repair is useful as it allows observation from the inside of the abdominal cavity.