Kugel法による鼠径ヘルニア術後に大腸穿通を来した盲腸憩室炎の1例  [in Japanese] Colonic Penetration after Kugel Patch Inguinal Hernia Repair  [in Japanese]

症例は69歳の男性で,主訴は右下腹部腫瘤.約2年前に,Kugel法による右鼠径ヘルニア手術を他院で受けていた.小児期の鼠径ヘルニア手術,急性虫垂炎手術の既往があった.CT,注腸検査で右側結腸憩室炎による膿瘍形成を疑い,手術を行った.回盲部が腹壁に強固に癒着しており,剥離するとメッシュが盲腸に癒着,穿通し一塊となり腫瘤を形成していた.メッシュを取り除き,回盲部切除術を行った.病理組織では膿瘍内に放線菌の菌塊を認めた.術後は麻痺性イレウス,surgical site infectionを起こしたが保存的に軽快した.過去に報告のない,Kugel法による鼠径ヘルニア手術後にメッシュが盲腸に穿通した症例を経験した.

A 69-year-old man was seen for a lower right abdominal tumor 2 years after right inguinal hernia repair with a Kugel patch. He was operated right inguinal hernia and appendectomy in childhood. Computed tomography (CT) and barium enema examination found to have an abscess formation due to right side colonic diverticulitis. Operative findings showed the cecum strongly adhering to the abdominal wall, with the patch adhering to and penetrating the cecum and forming part of the tumor. The patch was removed and the ileocecum resected. Actinomyces infection was recognized pathologically in the abscess. Despite paralytic ileus and postoperative surgical site infection, the man recovered with conservative treatment. This is, to our knowledge, the first report to demonstrate that colonic penetration after Kugel patch inguinal hernia repair.