腹腔鏡下に切除しえた成人出血性回腸重複腸管の1例

A case of adult bleeding ileal duplication resected by laparoscopy-assisted surgery

症例は19歳，女性．下血と軽度の腹痛を主訴に当院を受診した．腹部造影CT上，骨盤内に回腸末端部に連続する囊胞様構造を認め，回腸重複腸管と診断された．入院時の下部消化管内視鏡検査は，多量の凝血塊のため出血源の検索が不可能であった．出血が続くため緊急手術適応と診断したが，バイタル・サインが落ち着いているため，麻酔導入後に手術室において再度経肛門内視鏡検査を行い，Bauhin弁のすぐ口側の重複腸管内からの出血と確認した．この後，腹腔鏡下に重複腸管を含めた回盲部切除術を行った．術後創感染を発症したため入院が長期になり，第16病日に退院した．重複腸管の過去の報告例では，いずれも出血や腸閉塞などで緊急手術されるか，腫瘍性病変と診断されて待機手術されていた．筆者らの緊急手術症例も合わせて検討したが，本疾患の多くは腹腔鏡下手術の適応となると考えられた．

　A 19-year-old woman was admitted to our hospital because of abdominal pain and tarry stool. Abdominal CT scan revealed a cystic lesion in the pelvic space and it was diagnosed as a duplication of the alimentary tract. The source of bleeding could not detected by colonoscopy due to a large quantity of blood coagula. We decided to perform an emergency operation. We again performed colonoscopy after induction of anesthesia in the operating room when the vital signs became stable, and confirmed the bleeding was from a duplication of the alimentary tract immediately before the Bauhin valve. We performed laparoscopy assisted ileocecal resection with a diagnosis of ileal haemorrhage-related duplication of the alimentary tract. Hospitalization time was extended due to postoperative wound infection. In past reports, duplication of the alimentary tract was either operated on in emergency due to hemorrhage or ileus, or operated on electively when diagnosed as a neoplasn.