16歳男子にみられた腸管回転異常による先天性十二指腸狭窄症の1例

A Case of Congenital Anomalies of Rotation and Fixation of the Midgut with Volvulus in an Adolescent

　腸管回転異常に伴う先天性腸狭窄症例は現在まで多数の内外の文献があるが，なお稀な疾患であり，特に年長児に至るまで放置されていた症例は少ない．著者らは最近，頻回の嘔吐と腹痛を訴える16歳の患者で，消化管レ線検査を行なった結果本症であることを確認し，根治手術に成功した症例を経験したので，文献的考察を加えて報告する．

　Congenital anomalies of rotation and fixation of the midgut with volvulus in an adolescent and adult are rare. This is a report of a anomalous rotation and fixation of the bowel including its radiographic features and operative findings.

　Case: A 16-year-old boy. He was admitted to our hospital for the evaluation of recurrent vomiting and abdominal pain present since early childhood. He was often diagnosed mistakenly as suffering from autointoxication or psychosomatic disorders, because the symptoms seemed to be worse when he was standing and tended to be relieved when he adopted the knee-chest position. On admission, the pain was located in the epigastrium, and was often accompanied by nausea and vomiting. There was occasional visible peristalsis, which seemed to occur immediately after meals, lasting for several hours. Other physical findings were unremarkable and the blood chemistries were negative. The upper gastrointestinal series, progress meal, and barium enema study showed a congenital anomaly of rotation of the midgut, with the cecum and elongate ascending colon located in the center of the abdomen (Fig. 1～4). At surgical exploration, anomaly of the midgut with volvulus was found (Fig. 5). The postoperative course was uneventful. The patient was discharged symptom-free. During the past 19 months of follow-up, he has remained free of abdominal symptoms.