大網裂孔ヘルニアの２例

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  • TWO CASES OF TRANSEPIPLOIC HERNIA

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Transepiploic hernia is a rare disease. This paper deals with two cases of this disease.<br> Case 1: An 82-year-old woman who had the acute onset of abdominal pain, nausea, and vomiting after lunch was admitted to the hospital and underwent an emergency operation. About 30cm of the small intestine was impacted and strangulated in the hiatus near the inferior greater ometal free end. Because the impacted area became necrotic, the small intestine was resected. Case 2: An 82-year-old man was referred to the hospital because of the acute onset of epigastric pain and vomiting. An abdominal CT scan revealed ascites and the distended small intestine distributing in a radial manner from a point which seemed like a hernia hilus, anterior to the ascending and transverse colons. Obstruction of the small intestine due to transepiploic hernia was suspected. Initially conducted laparoscopy revealed bloody ascites and necrosis of the small intestine anterior to the right upper greater omentum, and a laparotomy was performed. Because at laparotomy the necrotic small intestine was impacted in an abnormal hiatus of the greater omentum, and then the greater omentum was incised and the small intestine was resected.<br> Even in the case of ileus without past history of undergoing laparotomy, transepiploic hernia should be included in differential diagnoses. Abdominal CT scan and laparoscopy appear to be useful for making the diagnosis.

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