腹腔鏡下に治療しえたMeckel憩室による腸閉塞の1例

A case of Meckel's diverticulum with intestinal obstruction successfully treated by laparoscopic surgery

◆要旨：患者は29歳，女性．腹痛，嘔吐を主訴に来院した．腹部単純X線および腹部造影CT検査にて腸閉塞を認めたため入院となった．イレウス管挿入後，小腸造影検査にて閉塞所見を認めたため，保存的治療は困難と考え腹腔鏡下に手術を行った．術中所見ではMeckel憩室からの索状物による小腸の絞扼性腸閉塞であったため，絞扼を解除後，索状物および憩室を腹腔鏡下に切離・摘出した．病理組織学的に索状物は卵黄血管の遺残であるmesodiverticular bandであった．術後経過は良好にて7病日目に退院となった．

　Meckel憩室に起因したmesodiverticular bandによる腸閉塞をイレウス管で減圧後，腹腔鏡下に治療した症例を経験したので報告する．

　A 29-year-old woman visited our hospital because of vomiting and upper abdominal pain. Plain abdominal X-ray and enhanced CT scan showed air fluid level formation in the small intestine, and she was admitted immediately with the diagnosis of intestinal obstruction. After placement of a long tube, small intestine radiography revealed obstruction of the jejunum. Since conservative treatment was ineffective, laparoscopic surgery was performed on the 5 th hospital day. The small intestine was strangulated by a band-like structure extending from the tip of the Meckel's diverticulum to the mesenterium of the ileum. After reduction of the strangulation ileus, Meckel's diverticulum with the band-like structure was resected by using a linear stapler.

　Histopathlogical finding of the resected band-like structure revealed a Mesodiverticular band, which is the remnants of the vitelline arteries.

　The postoperative course was quite uneventful. Laparoscopically, we successfully completed the treatment for ileus deriving from Meckel's diverticulum after placement of the long tube.