左傍十二指腸ヘルニアの2例 : 開腹手術の1例と腹腔鏡下手術の1例 TWO CASES OF LEFT PARADUODENAL HERNIA : LAPAROTOMY AND LAPAROSCOPIC REPAIR

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左傍十二指腸ヘルニアは先天的に生じた傍十二指腸窩に小腸が陥入する内ヘルニアの一つである.われわれは2例の左傍十二指腸ヘルニアを経験したので報告する.症例1は48歳,男性.左下腹部痛と嘔吐を主訴に入院. 10年程前から同様の症状を繰り返していたが,保存的に軽快していた. CT・小腸造影では左腹部に小腸の集塊像を認めた.腹腔鏡手術を試みたが,小腸の高度癒着のために開腹となった.症例2は66歳,男性.左上腹部痛と嘔吐を主訴に入院. 7年程前から同様の症状を繰り返していたが,保存的に軽快していた. CT・小腸造影では症例1と同様の所見に加え, CTにて小腸塊により右前上方に圧排・伸展された下腸間膜静脈が確認された.腹腔鏡下に根治術を施行した. CT・小腸造影は診断に有用であり,腹腔鏡は診断および治療に有用であった.高度癒着や絞掘を伴わない左傍十二指腸ヘルニアは腹腔鏡下根治術が可能である.

Left paraduodenal hernia is characterized by herniation of the small bowel loop into a congenital fossa in the paraduodenal area. This disease presents in preoperative diagnosis. We report two cases of left paraduodenal hernia. A 48-year-old man was admitted to the hospital because of left lower abdominal pain and vomiting. He had had similar episodes over these 10 years, and the pain had resolved spontaneously Computed tomographic (CT) scan and an upper gastrointestinal series with the smallbowel follow-through (UGI) showed accumulation of the small bowel on the left side of the abdomen. Laparoscopic hernioplasty was unsuccessful because severe adhesion of the small bowel was observed. So a hernioplasty was performed under a laparotomy.<br> A 66-year-old man was admitted because of a painful left upper abdominal mass and vomiting. He had had similar episodes over these 7 years, and the pain had resolved spontaneously. CT and UGI showed same findings as the first case. Laparoscopic hernioplasty was performed.<br> CT and UGI were useful for making the preoperative diagnosis because of their characteristic findings. Laparoscopic exploration was helpful ford diagnosis and decision making on operative method. It is thought that laparoscopic repair is indicated for non-strangulated left paraduodenal hernia without severe adhesion.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 63(5), 1302-1307, 2002-05-25

    Japan Surgical Association

参考文献:  15件中 1-15件 を表示

被引用文献:  8件中 1-8件 を表示

各種コード

  • NII論文ID(NAID)
    10008913478
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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