成人腸回転異常症に対し腹腔鏡下Ladd手術を施行した1例

A case of laparoscopic Ladd procedure performed for adult intestinal malrotation

◆要旨：腸回転異常症とは，胎生期での腸管の回転や固定の異常に起因した先天異常であるが，成人後に症状を発症することがある．成人で発症した場合には先天異常が疑われることが少なく，病悩期間が長い傾向にある．今回われわれは，成人で発症した症例を経験したので報告する．症例は22歳，女性．生来健康であったが，数日前より食事を摂るたびに嘔吐するため外来を受診した．腹部造影CT検査で腸回転異常症と診断した．待機的手術を行い，十二指腸と上行結腸の前面を覆うように薄い膜状の線維のLadd靱帯を同定し，腹腔鏡下Ladd手術＋予防的虫垂切除術を施行した．術後，癒着性イレウスなどの合併症なく3年が経過した．

　Intestinal malrotation is a congenital abnormality caused by abnormal rotation or fixation of the intestine during fetal development, but symptoms can develop after reaching adulthood. When it develops in adults, congenital abnormalities are rarely suspected, and symptoms tend to persist for a long time. In this report, we describe a case of adult-onset intestinal malrotation. A 22-year-old female without past medical history came to the outpatient clinic because of repeated vomiting that lasted for several days. She was diagnosed with intestinal malrotation by contrast-enhanced computed tomography scan of the abdomen. An elective operation was performed to identify the Ladd's ligament, a thin membrane covering the surface of the duodenum and ascending colon, and a laparoscopic Ladd's operation with prophylactic appendicectomy was performed. Three years have passed after surgery without complications.