傍上行結腸窩ヘルニアの1例

A case report of internal hernia in paracolic gutter of the ascending colon

◆要旨：症例は74歳，女性で，便秘と腹部膨満を主訴に当院を受診した．虫垂炎の手術歴があり，画像検査でcaliber changeを伴う腸閉塞を認め，腹部手術歴があることから癒着性腸閉塞と診断した．入院し保存的治療を開始したが症状は増悪傾向にあり，第3病日に臨時で審査腹腔鏡を施行したところ上行結腸外側に嵌入する小腸を認め，傍上行結腸窩ヘルニア嵌頓の診断となった．嵌頓した小腸を還納し，ヘルニア囊を開放して手術終了，術後経過は良好であった．傍上行結腸窩ヘルニアの報告は稀であり，その病態や治療法について文献的考察を加えて報告する．

　A 74-year-old woman with the history of appendectomy presented to our emergency department because of constipation and abdominal distension. Enhanced computed tomography revealed small bowel obstruction with caliber change. We diagnosed adhesive ileus and began conservative management. However, in 3rd day of hospitalization, we performed test laparoscopy because of a deterioration of her symptoms. We found a hernial hilus at lateral of the ascending colon and small intestine was incarcerated. We finally diagnosed small bowel obstruction with internal hernia in paracolic gutter of the ascending colon. We reduced the intestine to the abdominal cavity and opened the hernia sac. The postoperative course was uneventful. A case of internal hernia in paracolic gutter of ascending colon is rare, so we report pathology and treatment of it with a review of the literature.