緊急腹腔鏡にて診断・治療した虫垂の癒着による絞扼性イレウスの1例

A case of internal hernia due to adhesion of the appendix to the abdominal wall treated by emergency laparoscopic surgery

症例は17歳の男性．急激に発症した下腹部痛を主訴に緊急入院となった．右下腹部を中心に強い圧痛と筋性防御を認めた．腹部US・CTにて，少量の腹水と盲腸の内側に糞塊と思われる内容物を含んだ管腔構造を認め，圧痛の部位と一致した．急性虫垂炎・メッケル憩室・内ヘルニアなどを疑い，緊急腹腔鏡下手術を施行した．気腹法にて観察すると，虫垂先端が腹壁に癒着してバンドを形成し，ここをヘルニア門として回腸が入り込み内ヘルニアとなっていた．虫垂と腹壁の癒着を剝離したところ絞扼は解除され，腸管の血流も改善したため腸切除は行わなかった．腹腔鏡下に虫垂切除を行い終了した．術後経過は順調で特に合併症を認めず，術後7日目に退院した．

　A 17-year-old male was hospitalized in March 2006, with the chief complaint of sudden lower abdominal pain urgently with the main complaint being sudden lower abdominal pain in March 2006. Severe tenderness was felt mainly at the lower right quadrant along with muscular defense. An abdominal US and CT detected a small amount of ascites and a luminal structure that included contents which resembled a fecal mass inside the appendix. Its location matched that of the abdominal pain. Acute appendicitis, Meckel diverticulum and internal hernia, etc. were suspected, and laparoscopy was performed immediately. Laparoscopically, it was found that the tip of the appendix had adhered to the abdominal wall to form a band, and that the ileum had protruded through this to create an internal hernia. When the adhesion between the appendix and the abdominal wall was dissected the strangulation was released and the blood flow improved, and so an intestinal resection was not performed. Finally, a laparoscopic appendectomy was performed. The postoperative course was uneventful, and he left hospital on the seventh day after the operation.