腸回転異常症に起因する腸閉塞症に対して腹腔鏡下手術を行った2例

Laparoscopic surgery for intestinal malrotation : report of two cases

◆要旨：腸回転異常症は，成人期に慢性の腹痛などを契機に診断されることがある．［症例1］は15歳の女性．以前より慢性便秘症であった．2006年9月，腸閉塞で入院後，11月に再度腸閉塞で入院した．腸回転異常症に対して腹腔鏡下手術を施行した．右傍十二指腸ヘルニアの形態であった．術後，腸閉塞・腹痛は消失し，また，慢性便秘症も改善した．［症例2］は80歳の男性．以前より腹痛・嘔吐にて数回の入院歴があった．2006年11月，腸閉塞を繰り返すために，腸回転異常症に対して腹腔鏡下手術を施行した．右傍十二指腸ヘルニアの形態であった．術後腸閉塞が再燃し，小腸部分切除術を施行した．腹腔鏡下手術は腸回転異常症に対して診断・治療ともに有用な術式である．

　Intestinal malrotation, which is a developmental failure of rotation of the midgut in embryo phase, is often diagnosed in infants and rarely in adults. We report two cases of laparoscopic surgery for intestinal malrotation. Patient 1 was a 15-year-old woman who was admitted for abdominal pain and vomiting and diagnosed as intestinal obstruction. Abdominal computed tomography revealed intestinal malrotation.Laparoscopic surgery for intestinal malrotation was performed. The intestinal obstruction was caused by right paraduodenal hernia. Abdominal pain disappeared after the surgery, and an improvement of chronic constipation was observed also.

　Patient 2 was an 80-year-old man who was frequently admitted for abdominal pain and vomiting. We suspected that it was caused by intestinal malrotation causing intestinal obstruction. The intestinal obstruction was caused by right paraduodenal hernia. Laparoscopic surgery for intestinal malrotation was performed. However, the patient developed intestinal obstruction again. We perfomed mini-laparotomy-surgery for partial resection of ileum including the stenotic portion. Laparoscopic surgery is useful in the diagnosis and treatment of intestinal malrotation.