広範な後腹膜膿瘍をきたしたS状結腸間膜内ヘルニアの1例

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  • A CASE OF INTERMESOSIGMOID HERNIA CAUSING WIDE RANGE OF RETROPERITONEAL ABSCESS

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A 66-year-old man was admitted to the hospital because of vomiting, abdominal distension, and a swelling of the left scrotum which lasted for three days. Physically there were abdominal distension, flare and swelling of skin covering from the left flank to the inguinal region and scrotum. On blood chemistry, a remarkable increase in white blood cells, high level of CRP, and renal impairment were noted. Abdominal X-ray film revealed intestinal obstraction. CT visualized a wide range of retroperitoneal abscess extending from the left perirenal retroperitoneum to inguinal region and a swelling of the left spermatic cord. With a diagnosis of intestinal obstruction due to perforation of incarcerated inguinal hernia and retroperitoneal abscess, an emergency operation was performed. Upon laparotomy, no inguinl hernia was present and a defect on mesentery in the vicinity of the root of sigmoid mesentery was found. And the ileum perforated and incarcerated into the defect in the manner of Richter type, forming the retroperitoneal abscess. A diagnosis of intermesosigmoid hernia was made, and the perforated site of the ileum and the mesentery defect were closed by sutures, and abscess drainage was performed. The patient's life was successfully saved. There have been only 38 cases of the hernia involving the sigmoid mesocolon in the Japanese literature so far. Especially, this case is very rare that caused perforation of the incarcerated intestinal hernia forming retroperitnoneal abscess.

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