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左子宮広間膜異常裂孔ヘルニアの1例

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  • Internal Hernia Through a Defect in the Left Broad Ligament of the Uterus

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Abstract

子宮広間膜に生じた異常裂孔に起因する内ヘルニアは極めてまれで, 本邦ではこれまで50例の報告しかない.今回, 我々は異常裂孔に腸管が嵌頓し, イレウスとなった1例を経験したので報告する.症例は開腹手術の既往がない44歳の女性で, 腹痛, 嘔吐を認め来院, イレウスと診断され入院した.CTでは子宮の左側に拡大した腸管がみられたが確定診断できず, 保存的に治療を行った.第3病日に疼痛が増強したため, 原因不明のイレウスとして手術を施行したところ.左子宮広間膜に異常裂孔が存在し, 回盲弁から80cm口側の回腸が嵌頓していた.このため25cm長の壊死腸管を切除し, 異常裂孔を閉鎖した.本症は疾患の知識がないと術前に確定診断することは困難であるが, CTが診断の有力な手段となると考えられた.また, 開腹術の既往がないイレウス症例は, 子宮広間膜の異常裂孔等に起因する内ヘルニアを鑑別診断に加える必要があると考えられた. We report a rare case of internal hernia through a defect in the left broad ligament of the uterus. A 44-year-old woman, without any previous surgical operation, was admitted to our hospital because of vomiting and lower abdominal pain from early in the morning. On the plain roentogenogram of the abdomen, a small amount of small intestinal gas was pointed out. US and CT studies showed dilated small bowel loops at the left side of the uterus. The patient was diagnosed with ileus of unknown origin and treated conservatively. However, her pain continued and the small bowel gas on a subsequent roentogenogram had increased. Therefore, an emergency operation was conducted on the third hospital day. Intra-operatively, we found an abnormal defect in the left broad ligament, 5.0cm in diameter, and the ileum approximately 80cm proximal to the ileocecal valve, was herniated through this defect. After the herniated ileum was reduced, the defect was sutured and necrotized ileum was resected. With internal hernias, especially the rarest types, it is impossible to make a clear diagnosis before laparatomy. Only 50 such cases have been previously reported in Japanese literature. It is suggested that for female ileus patients without a history of surgery, we should consider this abnormal condition as a possible diagnosis, and CT may play an important role for correct diagnosis.

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