CTにて術前診断し初回に腹腔鏡アプローチを施行した虫垂炎を伴うAmyand's herniaの2例

Laparoscopic approach to treat Amyand's hernia concomitant with appendicitis : Two case reports

◆要旨：鼠径ヘルニア内に虫垂が嵌頓したAmyand's herniaは比較的稀な疾患である．今回筆者らはCTにて虫垂炎を伴うAmyand's herniaと術前診断し，腹腔鏡を併用した手術を施行した2例を経験した．症例1は腹腔鏡操作で虫垂が還納可能であったが，虫垂先端の壊死と限局性腹膜炎を認めたため，虫垂切除術のみを施行し，2期的にtension free法でヘルニア修復術を施行した．症例2は腹腔鏡操作では嵌頓した虫垂が還納できず，鼠径法を追加し虫垂切除を行った後，iliopubic tract法でヘルニア修復を施行した．Amyand's herniaでは虫垂炎を合併することを念頭に置き適切な治療を行う必要がある．その際，腹腔鏡でアプローチを行うことで低侵襲に正確な病態の把握と治療が行える可能性がある．

Amyand's hernia is a rare condition in which the appendix is included within the hernia sac. We report two cases of Amyand's hernia that were diagnosed preoperatively using computed tomography （CT） and were treated using laparoscopic and inguinal approach. Case 1: A man in his seventies presented to our hospital with a right inguinal mass. Right-sided indirect hernia that contained swollen appendix was noted on CT, and thus the patient was diagnosed as having an Amyand's hernia with appendicitis. An emergency laparoscopy was performed. Surgical findings revealed the head of appendix incarcerated in the right-sided indirect hernia orifice. Although the incarcerated appendix was reducible, its tip appeared necrotic and there was evidence of localized peritonitis within the hernia sac. Therefore we only performed laparoscopic appendectomy, and 90 days later, we performed tension free inguinal hernioplasty. Case 2: A man in his sixties presented to our hospital with a right inguinal mass. Right-sided indirect hernia that contained swollen appendix was noted on CT, and thus he was diagnosed as having an Amyand's hernia with appendicitis. An emergency laparoscopy was performed. The appendix was incarcerated in the right-sided inguinal hernia orifice, and was irreducible. Following an inguinal incision, we performed an appendectomy and a simultaneous hernioplasty with iliopubic tract repair. We consider laparoscopic surgery is a minimally invasive approach to accurately diagnose and treat Amyand's hernia.