腹腔鏡補助下に治療しえたMeckel憩室に起因した腸閉塞の1例

A case of intestinal obstruction caused by Meckel's diverticulum : successful management with the aid of laparoscopy

◆要旨：患者は61歳の男性で，腹痛と嘔吐を主訴に来院した．腹部単純X線とCT検査で腸閉塞と診断し，イレウス管を挿入した．イレウス管からの造影で回腸末端部に狭窄所見を認めたため，イレウス管挿入後8日目に腹腔鏡下に手術を行った．術中所見では，イレウス管による腸管の減圧で良好な視野が保たれていた．回腸末端部から20cm口側腸間膜の反対側にMeckel憩室を認め，その頂点と腸間膜との間に策状物があり，この間に回腸が嵌り込んでいた．4cmの小開腹を追加し，腸管を体外で切除，吻合した．経過は良好で，術後13日目に軽快退院となった．

　The patient, a 61-year-old male, reported to our hospital with complaints of abdominal pain and vomiting. Based on the findings from plain abdominal radiography and CT, a diagnosis of intestinal obstruction was given. An ileus tube was inserted, the image through which indicated a stenotic lesion at the ileal terminal. On the 8th day following ileus tube insertion, surgery was conducted under laparoscopy. During the surgical procedure, decompression of the intestine served to maintain a satisfactory visual field. Meckel's diverticulum was found opposite the mesentery and 20 cm orally from the ileal terminal. A cord-like structure was present between the apex of this diverticulum and the mesentery, entrapping the ileum. An additional small laparotomy incision （4 cm） was made for extracorporeal excision and anastomosis of the intestine. The postoperative course was satisfactory and the patient was discharged in good condition on day 13 after surgery.