術前ＣＴ検査が有用であった大網裂孔ヘルニアの１例

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  • A Case of Omental Hiatal Hernia in which Preoperative CT scan was Useful.

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Intraabdominal hernias are relatively rare, especially omental hiatal hernia with omental hiatus as a hernia opening. This disease lacks specific physical features, so that we have difficulty in making preoperative diagnosis and are able to diagnose at laparotomy very often. This time, we have experienced a case of omental hiatal hernia in which preoperative CT scan was useful.<br> A 93-year-old woman abruptly vomited and felt an abdominal pain while she was hospitalized in the department of orthopedics in our hospital for back pain. After she was referred to the department, a gastric tube was inserted and the clinical course was observed. The abdominal pain was not relieved, and an abdominal CT scan was conducted which revealed dilated small intestine and convergence of the mesenterium ventral to the transverse colon. Since she had no previous history of undergoing any laparotomy, an emergency operation was performed with a diagnosis of strangulated ileus due to omental hiatal hernia. Upon laparotomy, a 30cm portion of the jejunum about 50cm from the Treitz'ligament incarcerated into the omental hiatal hernia 5cm in diameter. Since the incarcerated jejunum did not necrotized, only a partial excision of the omentum including the omental hiatus was carried out. The patient was discharged from the hospital 30 days after the operation.

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