腹腔鏡下イレウス解除術を施行したS状結腸腹膜垂による絞扼性イレウスの1例

Strangulated ileus caused by epiploic appendages of the sigmoid colon : a case report

◆要旨：患者は63歳，男性．下腹部痛を自覚して当院を受診し，イレウスの診断で同日入院となった．S状結腸より小腸に及ぶ索状物と小腸の拡張像を認め，絞扼性イレウスの診断で腹腔鏡下イレウス解除術を施行した．S状結腸腹膜垂が小腸の漿膜へ癒着し，同部位へ小腸が陥入し絞扼されていた．腸管は非切除とし，S状結腸腹膜垂は切除して，術後7病日に退院となった．病理組織学的に出血を伴う脂肪組織を認めた．開腹既往を有する絞扼性イレウスは比較的多く認められるが，開腹既往のない結腸腹膜垂による絞扼性イレウスは比較的少ない．本症に対し，腹腔鏡下手術はアプローチ法の1つになりうるものと考えられ，文献的考察を加え報告する．

　We experienced a case of strangulated ileus caused by epiploic appendages. The patient was a 63-year-old man who arrived at our clinic with the chief complaint of abdominal pain in April 2011. He had no history of previous surgery. He was diagnosed as having ileus and was hospitalized. A computed tomography （CT） showed dilatation of the small bowel with strangulation, and he underwent emergency surgery by laparoscopic approach. Given the operative findings, which were indicative of strangulated ileus of the small intestine caused by a loop of epiploic appendages of the sigmoid colon, the appendix epiploica was resected and the ileus was relieved. Bowel resection was not required because ischemic change was not irreversible. The postoperative course was uneventful and the patient was discharged on the seventh postoperative day. The pathological findings showed an adipose tissue with hemorrhage and there was no malignancy. Intestinal obstruction due to an appendix epiploica, as found in this laparoscopic treatment, is thought to be rare. There have been very few reports of strangulated ileus caused by epiploic appendages; this is the 14th case, with the exception of the conference record in Japan. Although it is difficult to diagnose the presence of a strangulated ileus caused by epiploic appendages preoperatively, this disease must be kept in mind as a possible diagnosis when a strangulated ileus is demonstrated on CT. We discussed this case with literature review.