虫垂炎に対して保存的治療後に腹腔鏡下虫垂切除術を施行した完全内臓逆位症例

Laparoscopic appendectomy for appendicitis in a patient with situs inversus totalis : a case report

◆要旨：患者は43歳，男性．小児期に完全内臓逆位の指摘を受けていた．前日からの腹痛を主訴に救急外来を受診した．McBurney点と左右対称をなす左下腹部に圧痛が認められた．血液検査でWBC 13,500／μl， CRP 0.44mg／dl，腹部CTで左下腹部に虫垂と思われる構造物の腫脹が認められた．完全内臓逆位症例に発症した急性虫垂炎と診断し保存的加療目的に入院となり，症状軽快を認め3日目に退院となった．約2か月後に手術目的で再入院し，腹腔鏡下虫垂切除術を施行した．術後1病日より歩行・食事を開始し，経過良好にて術後5病日に退院となった．腹腔鏡下手術により臓器の位置関係を比較的容易に把握することができたと考えられる．

　We report case of a 43-year old male who was noted as having complete situs inversus since childhood. He came to the emergency room complaining of abdominal pain since the previous day. At the time of initial diagnosis, tenderness in the left lower abdominal quadrant, which was bilaterally symmetrical to McBurney's point, was observed. WBC was 13,500/μl, CRP was 0.44mg/dl, and tumefaction, which was assumed to be the appendix, was observed in the left lower abdominal quadrant by abdominal CT. Acute appendicitis with situs inversus totalis was diagnosed and the patient was admitted to the hospital for conservative treatment. Improvement in the symptoms was observed and the patient was discharged from the hospital on the third day. Upon patient request, elective surgery was scheduled, and the patient was re-admitted to the hospital for surgery approximately two months later. Laparoscopic appendicectomy was carried out. Each organ was confirmed to be located in the reverse position of normal anatomy, by the abdominal observation. One day after surgery, the patient began walking and eating. Five days after surgery, the patient was discharged from the hospital due to satisfactory progress. By surgery under laparoscope, intra-abdominal observation over a wide range was considered possible, and the relative position of each organ could be easily understood.