腹臥位CTで術前診断し，TAPP法を施行したinterparietal herniaの2例

Two cases of interparietal hernia diagnosed preoperatively by prone CT and treated by TAPP method

◆要旨：Interparietal hernia（以下，IPH）は鼠径部で腹壁のさまざまな層間に発生する稀なヘルニアであり，術前診断が困難で90％が嵌頓で発症するとされる．今回われわれはIPHに対し鼠径部除圧下腹臥位CTにて術前診断を行い，TAPP法を行った2症例を経験したため報告する．症例1は77歳，女性．CTで両側IPH，両側大腿ヘルニア，左閉鎖孔ヘルニアを認めた．術中所見では両側の内鼠径輪が開大し，頭側の筋層間および外鼠径輪方向にヘルニア囊が進展しており，それぞれTAPP法を施行した．症例2は71歳，男性．CTで左IPHを認めた．術中所見で頭側の筋層間および外鼠径輪方向にヘルニア囊が進展しており，TAPP法を施行した．ともに再発なく，経過観察中である．

　Interparietal hernia （IPH） is a rare hernia that occurs between various layers of the abdominal wall in the groin. Preoperative diagnosis is difficult and 90％ of patients develop incarceration. We report 2 cases of IPH diagnosed preoperatively by prone CT of the groin under decompressed position, and treated by TAPP method. Case 1: The CT scan of a 77-year-old woman revealed bilateral IPH, bilateral femoral hernia, and left obturator hernia. Intraoperative findings showed enlargement of the internal inguinal rings on both sides and hernia sac extending toward the cranial sides of the muscle layers and the external inguinal ring. Bilateral femoral rings and left obturator foramen were also enlarged. Case 2: The CT scan of a 71-year-old man revealed left IPH. Intraoperative findings showed enlargement of the internal inguinal ring, and the hernia sac extending toward the cranial sides of the muscle layers and the external inguinal ring. In each case, TAPP method was performed and follow-up is ongoing without recurrence.