腹腔鏡下手術術直後に発症した上腸間膜動脈症候群の2例

Two cases of superior mesenteric artery syndrome immediately following laparoscopic surgery

◆要旨：症例1：67歳，女性．胆石症の診断で腹腔鏡下胆囊摘出術を施行した．術翌日より食事を開始したが，5日目より嘔気・嘔吐が出現した．症例2：70歳，女性．上行結腸癌の診断で腹腔鏡下右結腸切除術を施行した．第3病日より経口摂取を開始したが，術後9日目に嘔吐が出現した．2症例ともにCT上，胃から十二指腸下行脚間で多量の消化管内容が貯留し，水平脚で上腸間膜動脈（SMA）による圧排閉塞像を認め，SMA症候群と診断した．2症例とも保存的治療により軽快し，食事を再開したところ問題なく経過し，退院となった．腹腔鏡下手術とSMA症候群発症の明らかな因果関係は不明であったが，潜在的な素因を有し，腹部手術を契機に発症したものと考えた．

Patient 1 : A 67-year-old woman, underwent a laparoscopic cholecystectomy for cholelithiasis. She was served a meal on the day following the operation. Vomiting occurred on postoperative day 5. Patient 2 : A 70-year-old woman, underwent a laparoscopic right colectomy for ascending colon cancer. She was served a meal on postoperative day 3. Vomiting occurred on postoperative day 9. Abdominal CT scan showed a large quantity of stored digestive juice between the stomach and the descending portion of the duodenum as well as narrowing at the third portion of the duodenum. In both cases, superior mesenteric artery syndrome was diagnosed. The patients were treated with conservative therapy, and their conditions improved. The clinical courses were uneventful after starting the diets, and the patients were discharged. No clear relationship was observed between laparoscopic surgery and the development of symptoms for superior mesenteric artery syndrome. We considered that the patients had a certain potential factor for superior mesenteric artery syndrome, and the symptoms developed after their conditions were ignited by the abdominal operations.