腹腔鏡下に切除した虫垂粘液囊腫軸捻転症の1例

A case of laparoscopic appendectomy for torsion of the vermiform appendix

◆要旨：患者は56歳，男性．主訴は右下腹部痛で，腹部CT上骨盤内に径7mm大の囊胞性病変を認めた．虫垂粘液囊腫を疑ったが炎症反応が上昇，腹痛の増悪を認め，膿瘍形成性虫垂炎も否定できず緊急手術を施行した．虫垂は囊胞状に腫大し，根部で捻転していた．術中に虫垂粘液囊胞腺腫と診断し，腹腔鏡下虫垂切除術を施行した．虫垂内腔に粘液貯留，捻転部にうっ血・壊死を認めた．病理所見で腫瘍性病変はなく，細胞異型も軽度であるため虫垂粘液囊胞腺種軸捻転症と診断した．本症は稀な疾患であり，本邦報告例は自験例を含め12例のみである．虫垂粘液囊腫は術前に良悪性の診断は困難であり，total biopsyとしての腹腔鏡下虫垂切除術は有用な術式と考えられた．

　A 56-year-old man was admitted to our hospital due to lower right abdominal pain. Blood tests revealed that, inflammation reaction was positive and a cystic mass was pointed out on abdominal CT. We suspected appendiceal mucocele from the CT findings, suggesting the possibility of acute appendicitis with abscess formation and necessitating emergency surgery on hospital day 1. Laparotomy showed the appendix swollen and twisted counter clockwise 720 degrees at the root of the appendix. Laparoscopic appendectomy was performed. The resected appendix was filled with mucin. Pathological findings showed the appendiceal wall had hemorrhage and necrosis, but without malignancy. We diagnosed torsion of the appendiceal mucocele. To our knowledge, torsion of the appendiceal mucocele is rare, with only 12 reports in Japanese literature including our case. It's difficult to diagnose whether the appendiceal cyst is benign or malignant before surgery. We suggested that laparoscopic appendectomy is useful as a total biopsy for diagnosis.