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症例は85歳の女性で,2年前に両側閉鎖孔ヘルニアに対しメッシュプラグを用いた修復術の既往あり.今回,左下腹部痛,嘔吐を主訴に受診し,腹部CTで閉鎖孔ヘルニア再発による嵌頓と診断され,緊急手術を施行した.開腹時,嵌頓は解除されていたが,両側の閉鎖孔は開大しており,両側ともに収縮,硬化したメッシュプラグと思われる硬結を触知した.右側はヘルニア嚢を反転しメッシュプラグとヘルニア嚢を切除し,シート状メッシュを用い修復した.左側はヘルニア嚢の反転切除ができず,ヘルニア門を直接縫合閉鎖し,さらに膀胱の一部を縫着し修復した.再発の原因は,前回手術で挿入されたメッシュプラグの収縮によるものと思われ,手術の際少なくともメッシュプラグの固定が必要で,再発の可能性も念頭におくことが肝要と思われた.閉鎖孔ヘルニアに対しメッシュプラグを用いた修復術後の再発の報告はなく,非常にまれな1例と思われ文献的考察を加え報告する.
We report the first case, to our knowledge, of recurrent bilateral obturator hernias after mesh plug hernioplasty. An 85-year-old woman admitted for lower left abdominal pain and vomiting who had undergone laparotomy and mesh plug hernioplasty for bilateral obturator hernias two years earlier was found in abdominal computed tomography (CT) to have a dilated small intestine and intestine incarcerated between the bilateral pectineal muscle and external obturator muscle. Emergency surgery under a diagnosis of bowel obstruction due to obturator hernia showed dilation of the small intestine and focal redness, with dilated bilateral obturator foramens and indurations thought to be mesh plugs palpable bilaterally. Recurrent obturator hernias apparently were caused by mesh plug contraction. On the right side, the hernia sac was reversed and cut off and the mesh plug excised. The right obturator foramen was covered with mesh sheet. The hernia sac on the left side could not be reversed, so the hernia orifice was repaired with a direct peritoneal suture and covered with part of the bladder. The postoperative course was uneventful and the woman was discharged two weeks postoperatively. In mesh plug hernioplasty for an obturator hernia, it is important to keep in mind the possibility of recurrence caused by mesh plug contraction.
