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術前診断可能であった虫垂炎術後の盲腸後窩ヘルニアの1例

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Other Title
  • A case of retrocecal hernia, caused by previous post-appendectomy adhesion formation, that was diagnosed by CT scan prior to successful surgical treatment.

Abstract

盲腸後窩ヘルニアは,盲腸周囲ヘルニアの一型で盲腸後隙にある腹膜の窪みに腸管が嵌入し生じる。術前診断は難しく,腹部CT での嵌頓小腸と盲腸との位置関係が重要である。今回,腹部CT で術前診断可能であった虫垂炎術後の盲腸後窩ヘルニアの1例を経験したので報告する。症例は87歳の女性。近医整形外科入院中に腸閉塞を疑われ当院へ転院となる。腹部CT で上行結腸から盲腸の背側に拡張した小腸を認め,回盲部は腹側に圧排されていた。盲腸後窩ヘルニアによる腸閉塞の診断で緊急手術を施行した。手術所見では,盲腸の背側に虫垂炎術後の癒着に起因した後腹膜との間隙があり,ここをヘルニア門として約10cm の回腸が嵌頓し腸閉塞を引き起こしていた。手術は癒着剥離後,嵌頓した回腸を部分切除した。CT による盲腸背側の拡張した小腸像は典型的な盲腸後窩ヘルニアの所見であり,速やかに手術的治療を行う必要がある。

Retrocecal hernia is one type of pericecal hernia, characterized by a segment of ileum trapped in the peritoneal pocket of the retrocecal recess. It can be difficult to make this diagnosis preoperatively, but CT scan may reveal a cluster of dilated bowel loops behind the cecum as a key finding of retrocecal hernia. Here, we present a case of retrocecal hernia, caused by previous postappendectomy adhesion formation, that was diagnosed by CT scan prior to successful surgical treatment. An 87-year-old woman was referred with a presumptive diagnosis of small bowel obstruction. Contrast-enhanced CT scanning revealed a trapped cluster of small bowel loops behind the cecum and ascending colon. Small bowel obstruction due to retrocecal hernia was diagnosed and an emergency laparotomy was performed. The ascending colon and cecum were displaced anteriorly and a segment of ileum approximately 10 cm in length had herniated into a retroperitoneal space formed by the post-appendectomy adhesions. The herniated ileal loops were resected, and the retroperitoneal space was opened Typical CT findings indicating a retrocecal hernia, such as images of dilated loops of small bowel behind the cecum, may facilitate correct diagnosis and permit timely surgical intervention.

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