消化管外アニサキス症と推定され腹腔鏡下イレウス解除術を行った1例

A case of extra-gastrointestinal parasitic small bowel obstruction treated by laparoscopic ileus operation

◆要旨：患者は27歳，女性．開腹歴なし．嘔吐，腹痛を主訴に来院した．腹部造影CTでcaliber changeを認め，イレウス管造影で上部空腸の狭小化を認めた．腸管減圧後，待機的に腹腔鏡下イレウス解除術を施行した．上部空腸漿膜面に連続した太い索状物が後腹膜と癒着しており，これにより腸管が狭窄していた．索状物を切除し，イレウスは解除された．索状物の病理組織学的検索では内部に壊死に陥った寄生虫様構造物を認めた．血清抗アニサキス抗体価は陽性であり，アニサキスの腸管外迷入により索状物が形成されイレウスの成因となったと考えられた．寄生虫による腸管外肉芽組織に起因したイレウスの報告は稀であるが，腹腔鏡下イレウス解除術は有用な治療手段の1つになりうると考えられた．

A 27-year old female who has not undergone any operation was admitted to the hospital because of abdominal pain and vomiting. Abdominal CT scan showed caliber change of the upper small intestine, and intestinal contrast study through a long tube revealed stenosis in that part. Laparoscopic ileus operation was performed after small bowel decompression by long tube. During the operation, we found a band which formed between the small intestine and retroperitoneum which caused the stenosis of the upper small intestine. After removing the band, the stenosis was released. Pathological findings showed that there was an necrotic tissue which consisted of dead parasitic worm-like structure in the band. Serum level of anti-Anisakis antibody was high. We surmised that the band was made of Anisakis larva embedded in the extra-gastrointestinal space, which caused the small bowel obstruction. This is a rare case in which ileus was caused by extra-gastrointestinal parasitic worm thought to be Anisakis larva. Laparoscopic surgery will contribute to the treatment of small bowel obstruction like this case.