腹壁瘢痕ヘルニア修復に用いたコンポジットメッシュによる盲腸穿通の1例  [in Japanese] A Case of Cecal Penetration after Repair of an Abdominal Incisional Hernia Using a Composite Mesh  [in Japanese]

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Abstract

症例は73歳,男性.67歳時,メッシュを用いた腹壁瘢痕ヘルニア修復術を他施設で施行された.その6年8カ月後,便秘のため息んだ後から腹痛が出現し,軽快しないため2日後に来院した.腹部CTで腹壁に不規則に変形したメッシュとガス像が認められ,消化管穿通によるメッシュ感染と診断して緊急手術を施行した.使用されていたメッシュは腹腔内に留置が可能なコンポジットメッシュで,メッシュ辺縁の腹腔側への折れ曲がりが認められた.メッシュと癒着した盲腸に穿通を認め,メッシュを除去して穿通部の縫合閉鎖を施行した.近年,腹壁瘢痕ヘルニアに対する手術では,コンポジットメッシュを用いた修復術が広く行われるようになっている.ポリプロピレンメッシュの層が腹腔側に露出した場合,消化管と強く癒着して腸閉塞や腸瘻形成などの合併症が起こる危険性があり,メッシュの腹壁への固定には十分な注意が必要と思われる.

A 73-year-old man developed abdominal pain after straining his abdomen due to constipation. He had undergone repair of an abdominal incisional hernia using a composite mesh in another hospital at the age of 67 years. He visited our hospital after 2 days because his abdominal pain persisted. Abdominal CT showed gas and an irregularly deformed mesh in the abdominal wall. A diagnosis of mesh infection due to intestinal penetration was made, and an emergency operation was performed. The composite mesh had been placed in the abdominal cavity, and folding of the mesh margin toward the abdominal cavity was observed. The mesh had adhered to, and had penetrated, the cecum. The mesh was removed, and the penetrated area was closed with sutures. For abdominal incisional hernias, repair using a composite mesh is widely performed. When the polypropylene mesh layer is exposed to the abdominal cavity, there is a risk of its strong adhesion to the intestinal tract, causing intestinal obstruction and enterocutaneous fistula. Therefore, mesh fixation at the abdominal wall requires careful attention.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 75(3), 721-725, 2014

    Japan Surgical Association

Codes

  • NII Article ID (NAID)
    130004696556
  • Text Lang
    JPN
  • ISSN
    1345-2843
  • Data Source
    J-STAGE 
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