横隔膜弛緩症に併発した胃軸捻転に対し腹腔鏡下胃壁固定術が有用であった1例

A case of gastric volvulus complicated with diaphragmatic relaxation in which laparoscopic gastropexy was effective

◆要旨：症例は86歳の男性で摂食障害を主訴に消化器内科を受診した．既往に左肺上葉切除術があった．胸部X線検査では左横隔膜の挙上と胃泡の左頭側への偏位を認め，上部消化管透視では胃の左上方偏位と通過障害を認めた．横隔膜弛緩症に伴う胃軸捻転症と診断したが，横隔膜形成術は肺損傷のリスクが高いと判断し，腹腔鏡下胃壁固定術を施行した．胃壁を尾側に牽引し3-0 barbed sutureにて胃を肝円索と腹壁に固定した．術翌日より経口摂取を開始した．食事も内服も摂取良好となった．術後1年目の現在，食事摂取が改善したことで体重が7kg増加している．横隔膜縫縮術が困難な症例に，腹腔鏡下胃壁固定術を行い良好な経過を得た症例を経験したため報告する．

　The patient was an 86-year-old man who visited the gastroenterology department with the main complaint of an eating disorder. The patient had a history of left upper lobectomy. Chest XP revealed elevation of the left diaphragm and displacement of the gastric bubble to the left head, and upper gastrointestinal fluoroscopy revealed left-upper deviation of the stomach and obstruction of passage. The diagnosis was gastric volvulus due to diaphragmatic elevation, but because diaphragmplasty was thought to carry a high risk of lung injury, the decision was made to perform laparoscopic gastropexy. The stomach wall was pulled caudally and the stomach was fixed to the ligamentum teres hepatis and abdominal wall using a 3-0 barbed suture. Oral intake began the day after surgery. The patient was able to take food and medication well. Now, one year after the operation, his weight has increased by 7kg due to improved dietary intake. We report a case in which laparoscopic gastropexy was performed in a patient in whom diaphragmatic plication was difficult and in which the patient's condition improved.