内視鏡的整復後，腹腔鏡下胃固定術を行った胃軸捻転症の1例

A patient with gastric volvulus treated by laparoscopic gastropexy after endoscopic repositioning

◆要旨：胃軸捻転症は比較的稀な疾患であるが，症例によっては手術療法が必要となる．今回，筆者らは胃軸捻転症に対して腹腔鏡下胃固定術を行い良好な結果を得たので報告する．患者は81歳，女性．2001年から現在まで原因不明による4回の急性胃拡張にて入院し，いずれも経鼻胃管による減圧で症状は改善していた．2007年3月，腹痛，嘔吐を主訴に当院を受診した．CT検査にて間膜軸性胃捻転の診断となり，入院した．経鼻胃管による減圧が不十分であったため，内視鏡的整復術を施行し症状は改善した．再発予防のために2007年4月，腹腔鏡下胃固定術を施行した．胃体部前壁と腹壁を3-0バイクリルで3針縫合固定した．術後経過は良好で再発はみられていない．

　Gastric volvulus is a relatively rare condition. In some cases, it requires surgery. We report a patient with gastric volvulus who was treated satisfactorily by laparoscopic gastropexy. An 81-year-old woman had been admitted to our hospital 4 times since 2001 for acute gastric dilatation of unknown origin. On each occasion, the symptoms had resolved after decompression with a nasogastric tube. In March 2007, the patient presented with the chief complaints of abdominal pain and nausea and was diagnosed as having gastric volvulus. A computed tomography（CT）scan revealed mesenteroaxial volvulus of the stomach, and she was again admitted to our hospital. Since decompression with a nasogastric tube did not achieve satisfactory results, endoscopic detorsion of the volvulus was performed, and her symptoms improved. Due to the recurrence of the volvulus in April 2007, laparoscopic gastropexy was performed using a 3-0 Vicryl suture. The patient's postoperative course was uneventful, and there has been no recurrence of the volvulus.