特発性大網捻転症に対し腹腔鏡下切除術を行った1例

A case of laparoscopic resection for primary omental torsion

◆要旨：特発性大網捻転症に対して腹腔鏡下手術を行った1例を経験したので報告する．患者は43歳，男性．左上腹部痛を主訴に近医を受診し，精査・加療目的にて当院を紹介され受診した．来院時，左上腹部に圧痛を認めた．腹部CT検査にて，横行結腸近傍の脂肪織に造影効果が異なる周囲の腸管との境界が明瞭な部位を認め，大網捻転症と診断した．腹腔鏡下所見では，左上腹部に大網壊死を認め，正常大網とともに腫瘍塊状となっており，小腸を巻き込み腹壁と癒着していた．以上の所見から，腹腔鏡下大網部分切除術を施行した．特発性大網捻転症は稀な疾患であり，術前診断は困難である．しかし，腹部CT検査は診断に，腹腔鏡下手術は治療に大変有用であった．

　We report a case of primary omental torsion that we resected by laparoscopic operation. A 43-year-old man was admitted due to left upper abdominal pain. Computed tomography（CT）showed a irregular fat-dense mass on the at vental side of the transverse colon. By abdominal CT, torsion of the greater omentum was diagnosed preoperatively.

　During laparoscopic surgery, part of the omentum was necrotic at the left upper quadrant, formed a tumorous mass with the rest of the omentum, rolled up the small intestine and adhered to the abdominal wall. We resected the necrotic part of omentum in the operation.

　Torsion of the greater omentum is a rare disease, and it is generally difficult to diagnose preoperatively. Abdominal CT is extremely useful for preoperative diagnosis, and laparoscopic surgery is satisfactory for treatment.