腹腔鏡下に診断・治療しえたMeckel憩室による結節形成を伴った絞扼性イレウスの1例

Strangulated ileus due to a knot-forming Meckel's diverticulum treated with a laparoscopic associated surgery : a case report

◆要旨：患者は44歳，女性．上腹部痛を主訴に近医を受診し，急性腹症の診断で当院に紹介となった．入院時，腹膜刺激症状はなかったが，臍下部の激しい疼痛を認めた．腹部造影CTで限局性小腸虚血の所見が認められ，絞扼性イレウスの診断で腹腔鏡下に腹腔内の観察を行い，左下腹部に虚血・壊死に陥った小腸のループが確認された．臍部のカメラポート孔を5cmの小開腹に拡大し，小腸を創外へ出し，ループを含めた虚血小腸を切除した．術後経過は良好であった．Meckel憩室による結節形成を伴った絞扼性イレウスは本邦で9例目と稀であるが，このような症例に対しても腹腔鏡下手術は鑑別診断および治療に有用であった．

　A 44-year-old woman suffering from severe abdominal pain was hospitalized for ileus. Operation was immediately performed after admission under the diagnosis of strangulated ileus from the findings of enhanced abdominal computed tomography. Under laparoscopic observation, strangulated ileum with a knot formed by Meckel's diverticulum was found. A small incision was made to the abdominal wall. The necrotic intestine with Meckel's diverticulum was resected and end-to-end anastomosis was performed. The clinical course was uneventful. Japanese literature review revealed nine patients, including ours, withT strangulated ileus due to a knot-forming Meckel's diverticulum. Laparoscopic associated surgery is useful for the diagnosis and treatment of the patients with strangulated ileus.