内ヘルニアを呈したMeckel憩室に対して腹腔鏡下手術を施行した1例

A case of Meckel's diverticulum with internal hernia treated by laparoscopic surgery

症例は46歳，男性．右下腹部痛と嘔吐を主訴に当科を受診した．原因不明の腸閉塞の診断にて緊急腹腔鏡下手術の施行となった．術中所見では，Bauhin弁より約100cm口側の回腸に発赤したMeckel憩室を認め，憩室が炎症によりさらに口側の小腸腸間膜に癒着していた．癒着により形成されたループに，憩室より口側の小腸が約15cmにわたり嵌入しており，内ヘルニアを呈していた．嵌入した小腸には壊死所見は認めなかった．腹腔鏡用自動縫合器にてMeckel憩室を切除した．本症例はMeckel憩室の炎症性癒着が原因と考えられる比較的稀な腸閉塞であり，診断と治療を目的に腹腔鏡下手術を施行した．手術歴のない腸閉塞を診断するに際し，本疾患も念頭に置く必要性がある．

　A 46-year-old man was admitted to our hospital because of abdominal pain in the right lower quadrant and vomiting. He was diagnosed as cryptogenic intestinal obstruction which was detected by abdominal X-ray examination and abdominal CT scan. Therefore, an emergent laparoscopic operation was performed. Meckel's diverticulum with inflammation was found in the ileum about 100 cm proximal to the Bauhin's Valve,and the inflammatory diverticulum was adhered to the mesentery of the small intestine. The internal hernia of the intestine about 15 cm in length, was found around the adhesion. The diverticulum was resected by laparoscopic automatic suture device, and the operation was completed. Intestinal obstruction caused by inflammatory adhesion of Meckel's diverticulum is relatively rare. However, it shoud be considered when the patient has no history of abdominal operation.