腹膜陥凹を認めない精索脂肪腫を伴ったヘルニア類似疾患にTAPPを施行した2例

Transabdominal preperitoneal repair of hernia-like lesions with spermatic cord lipoma without peritoneal depression：two case reports

◆要旨：腹腔内所見では腹膜陥凹（ヘルニア囊）を認めない精索脂肪腫を伴ったヘルニア類似疾患2例を認めたため報告する．症例1は63歳，男性．術前CT画像で，脂肪組織がヘルニア内容物である左外鼠径ヘルニアと診断した．腹腔内所見では腹膜陥凹を認めず，腹膜前腔をさらに検索すると，後腹膜脂肪組織の滑脱を認め，切除摘出することで筋膜欠損部の同定が可能であった．症例2は70歳，男性．右鼠径部痛にて受診された．症例1と同様に，腹腔内所見は腹膜陥凹を認めず，後腹膜脂肪組織を切除することで筋膜欠損部の同定が可能であった．腹腔内所見で腹膜陥凹を認めないヘルニア類似疾患も存在し，本疾患に関して診断および治療について文献的考察を加えて報告する．

　We report two hernia-like cases with spermatic cord lipoma without peritoneal depression（peritoneal sac）. Case 1: A 63-year-old male with a left groin mass visited our hospital. Based on abdominal computed tomography findings, he was diagnosed with left indirect hernia with fatty tissues. Intraoperatively, a peritoneal sac could not be identified. Transabdominal preperitoneal repair was performed, considering the possibility of a sacless hernia. A slippage of retroperitoneal fat was identified, and resection made it possible to identify the hernial orifice. Case 2: A 70-year-old male complaining of left groin pain visited our hospital. There was no peritoneal depression in the patient's abdominal cavity, and the hernial orifice could be identified by excising the retroperitoneal lipoma. In this study, we report the hernia-like disease that did not show a peritoneal depression along with its diagnosis and treatment and a review of relevant literature.