両側鼠径ヘルニアを合併したアンドロゲン不応症に対し、腹腔鏡下両側性腺摘出術および鼠径ヘルニア修復術を施行した１例

抄録

　We present a case of gonadectomy in androgen insensitivity syndrome (AIS), in which the gonad was difficult to remove because it was entrapped in the inguinal canal. A 22-year-old phenotypical female was referred to a previous hospital for primary amenorrhea. Her two sisters had AIS and her chromosome test showed a 46XY karyotype. Therefore, she was referred to our hospital for treatment. Pelvic MRI showed the left gonad in the abdominal cavity and the right one completely in the inguinal canal. We decided to perform laparoscopic bilateral gonadectomy and inguinal hernia repair. Laparoscopic observation revealed the left gonad in the abdominal cavity. The right gonad could not be observed from the abdominal side and completely fell into the inguinal canal. Therefore, we incised the preperitoneal cavity, expanded it to the inguinal canal, inverted it into the abdominal cavity, and removed the gonad. Since both internal rings were enlarged after gonadectomy, meshes (3D Max Light Mesh) were fixed accordingly with the transabdominal preperitoneal repair. As no complications occurred, the patient was discharged on the third postoperative day. Pathohistological observations showed no malignancy.

　In the case of gonadal enlargement associated with bilateral inguinal hernias in AIS, gonadectomy can be performed by expanding the preperitoneal space and pulling and guiding the gonads into the preperitoneal cavity from the inguinal canal. Furthermore, hernia repair can be performed if necessary.