腹腔鏡下に修復し得た鼠径ヘルニア偽還納の1例

A case of reduction en masse of an inguinal hernia treated by laparoscopic surgery

◆要旨：ヘルニア偽還納は稀な病態であり，診断や手術操作が困難であり開腹手術が行われることが多い．今回，腹腔鏡下に修復し得た鼠径ヘルニア偽還納の1例を経験したので報告する．

　症例は72歳，女性．右鼠径部痛を主訴に救急外来を受診した．右鼠径ヘルニア嵌頓と診断し用手還納したが，疼痛が持続した．超音波検査で右鼠径部に囊状病変の内部に拡張した腸管を認め，鼠径ヘルニア偽還納を疑い緊急腹腔鏡手術を施行した．小腸が肥厚した腹膜で嵌頓したまま腹膜前腔に腫瘤を形成しており，偽還納と診断した．腹膜絞扼輪を切開し嵌頓を解除し，transabdominal preperitoneal approach（以下，TAPP）法でヘルニア修復した．TAPP法は嵌頓の解除が簡便にでき，ヘルニア偽還納に対して有用な術式と考えられた．

　Reduction en masse of inguinal hernia is a rare condition and is generally treated by laparotomy because of diagnostic and procedural difficulties. We report the case of a reduction en masse treated by laparoscopic surgery.

　A 72-year-old woman presented to our emergency clinic with right groin pain. She was diagnosed with incarcerated right inguinal hernia and underwent manual reduction. Despite adequate reduction, her pain did not improve. Ultrasound examination showed a dilated segment of intestine in a cystic mass in the right groin. Reduction en masse of an inguinal hernia was suspected, and she underwent emergency laparoscopic repair using the transabdominal preperitoneal approach. Laparoscopic exploration showed intestinal prolapse into the preperitoneal space. We cut the fatty peritoneum, reduced the incarcerated loop of small bowel, and repaired the hernia defect by placing a mesh. Laparoscopic repair using the transabdominal preperitoneal approach may be a simple and useful alternative for treating reduction en masse.