術前診断し腹腔鏡補助下根治術を施行した左傍十二指腸ヘルニアの１例

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  • A CASE OF LEFT PARADUODENAL HERNIA DIAGNOSED PREOPERATIVELY AND TREATED BY LAPAROSCOPY-ASSISTED SURGERY

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We report a case of left paraduodenal hernia diagnosed preoperatively and treated laparoscopically. A 20-year-old man with acute epigastralgia and vomiting consulted to the hospital. Based on the findings of an abdominal CT scan, which revealed regional dilatation of small bowel in the left upper abdomen and stretched inferior mesenteric vein (IMV) located at the ventral edge of dilated intestinal loops, he was diagnosed to have a left paraduodenal hernia. After bowel decompression with short tube for two days, laparoscopic hernia repair was performed. On the paraduodenal fossa at the left side of the Treitz ligament, the hernial orifice was identified. The small bowel in the hernia sac was easily reduced into the abdominal cavity. However, in order to confirm the complete reduction of clustered small bowel in the sac and to avoid the IMV injury, the hernia repair was performed under the direct vision with mini-laparotomy. Based on typical findings of the abdominal CT scan, this disorder can be diagnosed preoperatively. Thereafter, an elective laparoscopic repair is recommended if the bowel decompression has been effectively performed.

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