S状結腸間膜内ヘルニアの1例 A CASE OF INTERNAL HERNIA OF THE MESENTERY OF THE SIGMOID COLON
症例は61歳の男性.就寝中に突然の腹痛を自覚した.近医での腹部単純X線検査でイレウスと診断され,精査加療目的に当院紹介入院となった.開腹手術,外傷の既往はなし.腹部CT検査では小腸全体の著明な拡張像を認めた.イレウス管の挿入により症状は軽快したが,排液の減少はなく,イレウスは解除されなかった.イレウス管造影でも原因不明であり,腫瘍を含めた閉塞性病変の存在を疑い,発症後13日目に手術を施行した.開腹所見では, S状結腸間膜左葉の2cm大漿膜欠損孔に回腸末端部から約30cm口側回腸が嵌頓しており, S状結腸間膜内ヘルニアと診断した.嵌頓を解除し欠損孔を閉鎖,循環障害は軽度であったことより腸切除を施行せず,手術を終了した. S状結腸間膜内ヘルニアの本邦報告例は,本例を含めて27例であり,中でも左葉欠損例は8例のみと極めて稀であった.
A 61-year-old man who had the abrupt onset of abdominal pain during sleeping was diagnosed as having intestinal obstruction following abdominal plain x-ray examination at another institution and was admitted to the hospital for further exploration. There were no previous histories of laparotomy and trauma. Abdominal CT scan showed remarkable dilatation of the entire small intestine. Symptomatic remission was attained by placing a long tube, but no decrease in discharge was observed and ileus was not released. Even after long intestinal tube fluoroscopy, the origin of the disease was still unknown. Thus the patient was operated on with a suspicion of possible existence of obstructive lesion including a tumor on the 13<sup>th</sup> day after the onset of the disease. Laparotomy disclosed that the ileum about 30cm proximal to the terminal ileum was incarcerated through a 2-cm sized defect on serosa of the left lobe of mesentery of the sigmoid colon. Internal hernia of the mesentery of the sigmoid colon was diagnosed. The hernia was released, the defect was closed, and then the operation was finished without performing intestinal resection because of a slight degree of ischemia.<br> Internal hernia of the mesentery of the sigmoid colon has been reported in 27 cases, including our case, in the Japanese literature. Of these 27 cases, the defect in the left lobe is so rare to be reported in eight cases.
- 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 67(10), 2474-2478, 2006-10-25
Japan Surgical Association