メッシュプラグの腹腔内露出による癒着性腸閉塞に対し腹腔鏡手術を施行した1例

Laparoscopic surgery for small bowel obstruction due to mesh plug after inguinal hernia repair : A case report

◆要旨：症例は79歳，男性．開腹手術歴なし．6年前に左鼠径ヘルニア，5年前に右鼠径ヘルニアに対しメッシュプラグ法による根治術が施行されていた．以後5年の間に計8回腸閉塞を反復し，当科紹介となった．CT検査では左下腹部に再現性のある腸管の狭小化を認め，腹腔内癒着の存在を疑い手術治療を行った．腹腔鏡で観察したところ，左鼠径部で腹腔内に露出したメッシュプラグと小腸の癒着を認め，閉塞の原因と判明した．腹腔鏡下に癒着を解除し，プラグの露出部は周囲腹膜を縫着し被覆した．以後腸閉塞の再発なく経過している．メッシュプラグによる腸閉塞は稀であり，また腹腔鏡手術を行った報告はなく，文献的考察を加え報告する．

　A 79-year-old man received mesh plug repair for left inguinal hernia six years ago, and for right inguinal hernia five years ago. Although he had no history of laparotomy, he developed small bowel obstruction eight times in the past five years. Since every abdominal CT showed caliber change in the same area of left lower abdomen, we decided to perform surgical treatment. Laparoscopic observation revealed that the intraperitoneal exposure of mesh plug has caused adhesive small bowel obstruction. Laparoscopic adhesiolysis was performed, and the exposed stump of mesh plug was covered with surrounding peritoneum. The postoperative course was uneventful without recurrence. Though mesh plug repair is a well-established method for inguinal hernia, it may cause serious complications involving intraperitoneal organs. There has been no previous report of laparoscopic surgery for small bowel obstruction due to mesh plug, and we report this case with literature review.