腹腔鏡下手術を施行したS状結腸間膜内ヘルニアの1例

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タイトル別名
  • LAPAROSCOPIC TREATMENT FOR INTRAMESOSIGMOID HERNIA-REPORT OF A CASE-

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A 33-year-old woman was admitted to the hospital because of sudden onset of left lower abdominal pain. There were no histories of abdominal surgery and abdominal injury. Abdominal CT scan revealed an incarcerated small bowel loop posterior aspect of the mesocolon.<br> The patient underwent conservative therapy using a long tube but no improvement of small bowel obstruction was attained. Bowel contrast study through the long tube revealed obstruction of the small bowel at the left lower abdomen. The diagnosis of internal hernia was made and a laparoscopic surgery was carried out on the 10th day after the onset of symptoms. A mesenteric defect was found in the left leaf of the sigmoid colon, and the small bowel about 15cm in length was incarcerated in the defect. Laparoscopic diagnosis was intramesosigmoid hernia. The incarcerated small bowel was reduced and the defect of the sigmoid mesocolon was closed by suturing laparoscopically. No intestinal resection was required.<br> The postoperative course was uneventful and the patient was discharged from the hospital on 6th postoperative day.<br> Intramesosigmoid hernia is a very rare entity. Only 38 cases, including ours, have been reported in Japan. We present some discussion of internal hernia involving the sigmoid mesocolon and the usefulness of CT. CT may be the most reliable diagnostic modality in identifying the presence of closed loop obstruction as well as the location of intramesosigmoid hernia.

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