位置異常のない脾捻転および脾梗塞に対し腹腔鏡下脾固定術を施行した1例

A case of splenic torsion and splenic infarction without an abnormal position in which laparoscopic splenopexy was performed and the spleen could be preserved

◆要旨：症例は1歳9か月，女児．嘔吐と発熱を主訴に受診したが，診断確定には至らず，初発症状出現5日後に撮像した造影CTで脾捻転・脾梗塞が疑われ，緊急審査腹腔鏡手術を施行した．脾動静脈は脾門部で反時計方向に360度捻転していたが，位置異常は認めなかった．捻転解除後，脾実質の色調改善が認められたため，腹膜外ポケットを作成し大網被覆を併用することで脾臓を温存固定しえた．術後再発を認めず経過は良好であった．遊走脾を合併した脾捻転の報告はしばしば散見されるが，遊走脾を合併しないものは比較的稀である．診断に難渋し脾臓摘出術に至る例も少なくないが，複数の術式を組み合わせてでも，可能な限り脾温存を目指すべきであると考えられた．

　A 21-month-old girl presented with vomiting and fever, and a enhanced CT suggested splenic infarction with torsion 5 days after the first onset. An emergency laparoscopic exploration was performed on the same day. The operative findings showed that the spleen was twisted 360 degrees counterclockwise without anatomical dislocation and gastric volvulus. After de-torsion, the color of splenic surface improved, and the surgical team decided to preserve the spleen. An extraperitoneal pouch was created and the spleen was stored and fixed in that pocket with a combination of a large mesh and direct peritoneal suture. Her postoperative course was uneventful. Although there are several reports concerning splenic torsion due to wandering spleen, torsion without anatomical dislocation is relatively rare. Moreover, many cases with splenic torsion required total splenectomy, we could preserve the spleen using retroperitoneal fixation. The physicians should consider splenic-preservation surgery if possible, particularly in children.