術前に左卵巣囊腫と診断された右卵管留水症捻転の1例

Isolated torsion of right hydrosalpinx with preoperative diagnosis of left ovarian cyst : a case report

◆要旨：患者は44歳，3回経妊，3回経産．左下腹部痛を主訴に前医を受診し，経腟超音波とMRI所見から9cm大の2房性の左卵巣囊腫が疑われた．腹痛は自然軽快し，同月当科初診時，腫瘍マーカーの上昇を認めず，左漿液性囊胞腺腫と診断し，翌月に腹腔鏡下手術を施行した．両側卵巣は正常で，右卵管留水症であり，狭部で2か所360°の捻転を認めた．病理検査では卵管壁への炎症細胞浸潤は乏しく，卵管留水症捻転の原因は過去2回の帝王切開術の既往によるものが最も疑われた．今回，筆者らは術前診断が困難であった卵管留水症捻転症例を経験したので文献的考察を含めて報告する．

The patient is a 44-year-old woman who is 3-gravida 3-para. She visited another hospital complaining of left lower abdominal pain. Left ovarian cyst, 9 centimeters in size, was suspected from MRI and transvaginal ultrasound findings. The pain was relieved spontaneously. When the patient first visited our department in the same month, our diagnosis was left serous cystadenoma, considering the normal tumor markers. Laparoscopic surgery was performed the next month. The operative finding was normal bilateral ovaries with isolated right hydrosalpinx and 360 degrees torsions at two sites in the tubal isthmus. Since pathological findings revealed relatively scattered inflammatory infiltrates, the cause of torsion was considered to be adhesion from prior cesarean sections. We report a case of hydrosalpinx that was difficult to diagnose preoperatively with a literature review.