自転車ハンドルによる外傷性腹壁ヘルニア(Spigel hernia)の1例  [in Japanese] A Case of Traumatic Abdominal Wall Hernia (Spigel Hernia)  [in Japanese]

症例は10歳男児.自転車で走行中転倒した際ハンドルで右下腹部を強打し,同部に膨隆が認められたため当院を受診.右下腹部に手拳大の膨隆と圧痛を認め皮下に腸管を触知した.腹部CTにて遊離ガス像や臓器損傷はなく,右傍腹直筋部の皮下に小腸の脱出を認めた.臥位安静にて右下腹部の膨隆は消失するが腹圧にて再発するため,外傷性腹壁ヘルニアの診断にて全身麻酔下に手術を行った.右傍腹直筋切開で皮切を行うと,右腹直筋鞘外縁で腹壁が断裂しておりSpigel herniaと診断した.ヘルニア門は弓状線の高さから尾側へ約7cmの長さで存在し,腹腔内臓器の損傷はなく,腹壁の修復は各層で直接縫合し得た.術後2年経過し,再発は認めていない.小児の外傷性腹壁ヘルニアは稀で,検索し得た範囲内で自験例は外傷によるSpigel herniaの本邦報告例中最年少であった.

Acute traumatic abdominal wall hernia is rare and Spigel hernia is uncommon in children. Here, we report a case of traumatic abdominal wall hernia caused by impact with bicycle handlebars in a 10-year-old boy involved in a traffic accident. The patient presented with a soft and round mass and pain in the lower right quadrant of the abdomen. A defect in the Spigelian fascia as the hernia orifice was demonstrated on abdominal computed tomography (CT), and intra-abdominal contents protruded from the small intestine into the abdominal wall. CT and blood laboratory data indicated no injury to other organs. The contents were reduced by bed rest in the supine position. Surgery was performed 6 days after the accident. The orifice could be found and recognized easily through a paramedian incision. The orifice of the hernia was located at the Spigelian aponeurosis with the defect of the peritoneum and external oblique aponeurosis, lateral to the rectus abdominis muscle. Hernioplasty was performed by ligation of each layer. The patient is currently in good health without recurrence three years after the operation.