腹腔鏡下スリーブ胃切除術および胆嚢摘出術中に偶発的に発見された横隔膜ヘルニア：症例報告

Diaphragmatic hernias in adults are uncommon, especially when discovered incidentally during surgery for unrelated abdominal pathology. Incidental findings during bariatric surgery, such as diaphragmatic hernias, pose challenges in intraoperative decision-making. We report a rare case of a large left-sided diaphragmatic hernia discovered during laparoscopic sleeve gastrectomy. A 34-year-old male patient with morbid obesity (BMI 45.17 kg/m²), chronic calculous cholecystitis, and right hypochondrial pain underwent planned laparoscopic sleeve gastrectomy and cholecystectomy. Intraoperatively, a large left diaphragmatic hernia containing colon and small bowel was identified, but laparoscopic sleeve gastrectomy was aborted due to a lack of consent for hernia repair and the complexity of the concurrent procedure. Cholecystectomy proceeded uneventfully, with histopathology confirming chronic cholecystitis. Postoperative recovery was smooth, with a pending management plan for the unrepaired hernia. This case illustrates the importance of thorough preoperative imaging, anticipation of possible anatomic surprises, and sufficiently broad consent in bariatric surgery. Surgeons should be alert to suggestive imaging findings and ready to modify operative plans.