腫瘤形成性虫垂炎に対して腹腔鏡下にinterval appendectomyを施行した1例

Laparoscopic interval appendectomy for appendiceal mass

◆要旨：患者は66歳，男性．脳梗塞の既往がありアスピリンを内服中であった．右鼠径部の膨隆を主訴に2008年1月に当科を受診した．血液検査にて白血球とCRPが上昇し炎症所見があった．CT検査ではヘルニア内容が大網の鼠径ヘルニアと後腹膜膿瘍を伴う腫瘤形成性虫垂炎を認めたが，保存的に経過をみた．下部消化管内視鏡検査にて腫瘤性病変を認めなかった．3か月の経過観察後，腹腔鏡下虫垂切除術を施行した．回盲部が腹膜に癒着し，その背側に炎症のない虫垂があった．癒着剝離と虫垂切除は容易で，術後合併症はなく経過良好であった．腫瘤形成性虫垂炎に対する腹腔鏡下interval appendectomyは整容性と安全性に優れた有用な術式であると思われた．

　A 66-year-old man, who had been taken aspirin due to cerebral infarction, visited our hospital complaining of right inguinal swelling in January 2008. Biochemical blood examination showed increased white blood cell and C reactive protein. Computed tomography（CT）showed a right inguinal hernia filled with the omentum and mass-forming appendicitis with retroperitoneal abscess. I Interval appendectomy was planned as a treatment. Colonoscopy revealed no sign of colon cancer . The laparoscopic appendectomy was performed with an interval of 3 months. The operative findings revealed adhesion of ileoceal region to the retroperitoneum, and the appendix without inflammation was confirmed behind the terminal ileum. Laparocopically, dissection of the adhesion and appendectomy were easily performed. The postoperative course in the hospital was satisfactory and uneventful. The laparoscopic interval appendectomy for appendiceal mass may be recommended because of its safe procedure and cosmetic advantages.