術前診断し得た大網裂孔ヘルニアの1例

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  • A CASE OF TRANSEPIPLOIC HERNIA SUCCESSFULLY DIAGNOSED PREOPERATIVELY

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Transepiploic hernia is a rare disease and lacks in specific symptoms. So it is difficult to diagnose preoperatively. We experienced a case of transepiploic hernia which was successfully diagnosed by abdominal CT preoperatively.<br> A 63-year-old woman was admitted to the hospital because of lower abdominal pain and vomiting. A simple abdominal X-ray film showed some enlarged intestinal gas shadow and we diagnosed the case as ileus. The patient was observed conservatively with a long tube. On 4th hospital day, abdominal CT was performed because of lasting abdominal pain. CT showed much of ascites and the small intestine located over the transverse colon. By puncture bloody ascites was confirmed. A diagnosis of strangulated ileus by transepip-loic hernia was made and an emergency operation was performed. Through a hiatus of the omentum about 3cm in diameter, about 130cm of the ileum prolapsed and necrosed. We performed a resection of the necrosed intestine and an open incision of hiatus of the omentum.<br> In the Japanese literature, 34 cases of transepiploic hernia (type A) have been reported so far, but no other cases than this case could be diagnosed preoperatively.

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