腹腔鏡下に治癒しえたループ状S状結腸腹膜垂による腸閉塞の1例

Small bowel obstruction by looped epiploic appendix of sigmoid colon treated by laparoscopic procedure : a case report

◆要旨：ループ状となったS状結腸腹膜垂を原因とする稀な腸閉塞に対し，腹腔鏡下に治療を行ったので報告する．患者は65歳，男性．前日からの嘔吐と腹痛を主訴に受診した．腹部CTで右下腹部にclosed loopを伴う小腸閉塞像を認めたが腸管虚血を疑う所見を認めず，イレウス管を留置し3日後に腹腔鏡下手術を行った．術中所見としてS状結腸腹膜垂がループを形成し，これに小腸がループ状に嵌頓していた．腹膜垂から小腸を抜き閉塞を解除し，腸切除は行わなかった．術後経過は良好で術後4日目に退院となった．S状結腸腹膜垂がループを形成し腸閉塞の原因となったものは自験例を含め本邦で9例の報告があるが，完全腹腔鏡下に治療を完遂したのは自験例のみであった．

A 65-year-old man visited our hospital with complains of vomiting and abdominal pain lasting for a day. Abdominal computed tomography revealed closed-loop small bowel obstruction. There was no sign of bowel ischemia and laparoscopic surgery was performed following three days of treatment with a long gastrointestinal tube. His small bowel was incarcerated in a looped band that was formed from the appendix epiploica of the sigmoid colon. The small bowel was pulled out and released ; the bowel resection was not necessary. The patient was discharged four days after surgery without any complications. Reports of small bowel obstruction caused by looped appendix epiploica of the sigmoid colon are rare, and only 9 cases have been reported in Japan. To our knowledge, this is the first reported case treated by laparoscopy alone.