巨大鼠径ヘルニア嵌頓の1例 [in Japanese] A CASE OF INCARCERATION OF A HUGE INGUINAL HERNIA [in Japanese]
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今回,治療に難渋した巨大鼠径ヘルニア嵌頓の1例を経験したので報告する.症例は63歳,男性. 10年程前より右陰嚢の腫大に気付き,増大傾向であったが放置していた. 2年前より気管支喘息の治療を受けている.早朝より粘血便,下腹部痛が出現し,増悪してきたため夕方に来院した.来院時右鼠径部から陰嚢にかけて著明に膨隆し,陰嚢底部は臥位で右膝関節直上付近まで達していた.右下腹部を中心に強い圧痛を認め,腹部単純X線検査および腹部CT検査でイレウス像と右鼠径部から陰嚢内に及ぶ腸管ガス像を認めた.以上より巨大右鼠径ヘルニア嵌頓の診断で緊急手術を施行した.まず右鼠径部を切開し鼠径管を開放すると,空腸から上行結腸まで約300cmの腸管が脱出し空腸の一部が壊死していた.鼠径法では還納が困難であったため,上腹部正中切開を追加し脱出腸管を腹腔内に還納した.ヘルニア門は超手拳大で, PROLENE<sup>®</sup> Hernia System (L サイズ)を用い修復した.術後腹腔内圧の上昇もあり,気管支喘息重積発作を併発するなど呼吸状態が悪化した.早期離床が困難となり,深部静脈血栓症予防など慎重な周術期管理が必要であった.
We report a case of incarceration of a huge inguinal hernia which was difficult to treat.<br> A 63-year-old man who had noticed swelling on the right side of the scrotum since 10 years previously but left it alone despite its tendency to increase. He had a 2-year history of medical treatment for bronchial asthma. He presented in the evening because stools with mucus and blood and lower abdominal pain which had occurred in the early morning became aggravated. When he was seen, prominent bulging from the right inguinal region to the scrotum was noted and the fundus of the scrotum reached an area just above the right knee joint when in a recumbent position. There was severe tenderness, mainly in the right lower abdomen. Abdominal plain x-ray and abdominal CT scan showed ileus findings as well as intestinal gas extending from the right inguinal region to inside the scrotum. Accordingly incarceration of a huge right inguinal hernia was diagnosed and an emergency operation was performed. When the inguinal region was incised and the inguinal duct was released, prolapse of about 300cm of intestine from the jejunum to the ascending colon was recognized and a part of the jejunum had become necrotic. Since hernia reduction was impossible by means of the inguinal method, a median incision on the upper abdomen was added and the prolapsed intestine was reduced into the abdominal cavity. The hernia hilum was fist-sized or larger and was repaired using a PROLINE<sup>®</sup> hernia system (size L). After the operation his respiratory condition became worse due to attacks of bronchial asthma which might have resulted from a postoperative increase in intraabdominal pressure. The patient had to stay in bed and required careful perioperative management, including prevention of deep venous thrombosis.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 66(10), 2607-2611, 2005-10-25
Japan Surgical Association