尿管坐骨孔ヘルニアに対する腹腔鏡下修復術の1例

Laparoscopic repair of a ureteral sciatic hernia : A case report and review of the literature

◆要旨：坐骨孔ヘルニアは頻度の低い外ヘルニアで，腸管や卵巣の脱出が多く，尿管坐骨孔ヘルニアの報告は稀である．症例は71歳女性で，6日前から左側腹部痛を認め，当院へ救急搬送された．CTでは左水腎症を認め，拡張した左尿管が坐骨孔に連続し，尿管坐骨孔ヘルニアによる腎盂腎炎が示唆された．抗生剤投与下で経過をみたが，炎症反応の改善は得られなかった．第7病日，MRIで左坐骨孔近傍での尿管の屈曲狭窄残存が確認できたため，ドレナージ目的に尿管ステントを留置し，嵌頓は解除された．腹腔鏡下修復術を施行，左尿管と連続した脂肪組織をヘルニア門である大坐骨孔から引き出し，孔内にプラグ型メッシュを2個挿入した．術後4日目に退院した．

　Sciatic hernia is an infrequent external hernia, most commonly incarcerating the bowel and ovaries ; case reports of ureteral sciatic hernias are extremely rare. A 71-year-old woman was referred to our hospital with left-sided abdominal pain for 6 days, and a computed tomography scan revealed left hydronephrosis and a dilated left ureter contiguous to the sciatic foramen, suggesting pyelonephritis due to a ureteral sciatic hernia. Antibiotics were administered to the patient ; however, the inflammatory response did not improve. Magnetic resonance imaging showed residual stenosis of the ureter in flexion near the left sciatic foramen ; therefore, a ureteral stent was placed on day 7 of hospitalization, and the hernia was repositioned. Laparoscopic repair was performed, and the left ureter and contiguous fatty tissue were pulled out through the greater sciatic foramen, which was the hernia orifice, and two plug-type meshes were inserted into the orifice. The patient was discharged on the 4th postoperative day with a good postoperative course.