腹腔鏡補助下に切除した成人回腸重複症の1例

An adult case of duplication of the ileum resected by laparoscope assisted surgery

◆要旨：患者は58歳，女性．腹痛，発熱を主訴に当科を紹介され受診した．腹部所見では自発痛を認めるのみで，CTでは麻痺性腸閉塞と診断されたため，経過観察目的で入院となった．翌日，腹部反兆痛が出現し，CTで穿孔性虫垂炎と診断されたため腹腔鏡下手術を施行した．腹腔内を観察すると汚染腹水が多量に認められたが，虫垂は正常であった．回腸の腸間膜側に母指頭大の炎症を伴った突出物が認められたため，これを責任病変と考えて切除した．病理組織学的所見で回腸重複症と診断された．術後経過は良好で第11病日目に退院となった．消化管重複症は稀な先天性消化管奇形であり成人発症例は少ない．今回，筆者らは腹腔鏡補助下に切除した成人回腸重複症の1例を経験したので報告する．

　A 58-year-old woman was referred to our hospital with a chief complaint of abdominal pain and fever. Physical examination showed only visceral pain and computed tomography showed paralytic ileus. We performed a follow up in hospitalization, but physical examination showed rebound tenderness the next day. Since the diagnosis was perforated appendicitis in computed tomography, we performed emergency surgery by laparoscopy. At surgery, a large quantity of purnlent ascites was confirmed but appendix was normal. A process with inflammatory chage was on the mesentery side of the ileum and it was resected. Histological examination indicated duplication of the ileum. The patient's post operative course was uneventful, and she was discharged from the hospital on the 11 st postoperative day. Alimentary tract duplication is rare in adults. We report an adult case of duplication of the ileum resected by laparoscope assisted surgery.