腹壁瘢痕ヘルニア囊内の魚骨穿孔に対して腹腔鏡手術を施行した1例

A case of small intestinal perforation by a fish bone in an incisional hernia

◆要旨：症例は76歳，女性．開腹手術後に腹壁瘢痕ヘルニアを指摘されるも経過観察されていた．当院受診2週間前からの腹壁瘢痕ヘルニア部の皮膚の発赤と疼痛を主訴に近医を受診し，当科紹介受診となった．腹部造影CT所見にてヘルニア囊内に線状の高吸収域と含気を伴う膿瘍形成を認めた．魚骨穿孔の診断で緊急手術を行う方針とした．術中所見ではヘルニア囊内の小腸に魚骨が穿通しており，魚骨は腹壁を貫いて腹壁に膿瘍を形成していた．腹腔鏡補助下に穿孔部を含めた小腸部分切除術，経皮的に腹壁膿瘍ドレナージ術を施行した．腹壁瘢痕ヘルニア囊内に魚骨穿孔を呈した症例は過去に報告がほとんどなく，非常に稀な1例を経験したので報告する．

　A 76-year-old woman was referred to our hospital to investigate the cause of redness and pain at the site of the ventral and incisional abdominal wall hernia. CT scan revealed a linear hyperabsorbable image with abscess in the hernia sac. We diagnosed it as an intestinal perforation with abscess caused by a fishbone in the incisional hernia sac, and we concluded that surgery was necessary. Surgical finding revealed a fishbone that penetrated the intestine in the incisional hernia sac and the abdominal wall, forming subcutaneous abscess. Laparoscopically assisted partial bowel resection and abscess drainage were performed. We report a very rare case of intestinal perforation caused by a fish bone in an incisional hernia sac.