腹腔鏡下修復術を行った大腿ヘルニア嵌頓の一例

A case of femoral hernia with incarcerated small intestine treated with laparoscopic surgery

Creators Ayata Ryo

Creators Tsushimi Takaaki

Creators Fukamitsu Gaku

Creators Oka Kazuhito

Creators Sudou Manabu

Creators Minami Yoshihide

症例は79歳の女性.突然の腹痛,右鼠径部腫脹を認め,徐々に痛みが増悪したため,当院へ救急搬送された.右鼠径部に胡桃大の圧痛を伴う膨隆を認めた.用手環納は不可能であった.腹部･骨盤部単純CTで右鼠径部の大腿動静脈内側に小腸とみられる腫瘤を認め大腿ヘルニア嵌頓と診断し緊急手術となった.全身麻酔下に体位を仰臥位とし手術を開始した.腹腔鏡で腹腔内を検したところ小腸が右大腿輪に嵌頓していた.嵌頓小腸を鉗子で軽く牽引しつつ,iliopubic tractと思われる嵌頓周囲組織を超音波凝固切開装置で切開することで嵌頓小腸を引き出した.嵌頓小腸は暗赤色調に変化していたが明らかな壊死は認めなかった.腹膜前腔の剥離を進め,ポリソフト®(Bard社)メッシュを使用しヘルニア修復術を行った.再度,嵌頓小腸を確認し,色調が改善していること確認した.手術時間は56分,出血は少量であった.術後3日目に軽快退院した.

A 79-year-old woman with acute abdominal pain and a right groin swelling was referred to our hospital. She had a soft swelling of approximately 3 cm in diameter in her right groin that could not be reduced. Abdominal computed tomography revealed a right-sided femoral hernia with incarcerated small intestine. Because she had been diagnosed with a incarcerated femoral hernia, we decided to perform emergency laparoscopic hernia repair. Laparoscopy confirmed incarceration of the small intestine into the right femoral canal. The strangulated small intestine was released through mild traction and cutting the iliopubic tract with an ultrasonic incision and coagulation device. The strangulated intestine was dark brown in color

[ISSN]0513-1731

[NCID]AN00243156