幽門側胃切除Roux-Y再建術後に発生した十二指腸憩室炎に対する腹腔鏡補助下手術の1例

A case of duodenal diverticulitis after distal gastrectomy with Roux-en-Y reconstruction treated by laparoscopic surgery

◆要旨：患者は50歳の女性で，腹腔鏡下幽門側胃切除，Roux-Y再建術の既往があった．上腹部痛で近医を受診し，腹膜炎と診断され当院に救急搬送された．腹部CTにて十二指腸憩室内結石に伴う憩室炎と診断し，腹腔鏡下に緊急手術を施行した．憩室は膵側に存在し，結石が充満して高度の炎症を伴っていた．憩室の処理は縫合不全のリスクが高いと判断し，十二指腸切開による憩室内結石の除去と腸管内容のうっ滞を改善する目的に十二指腸空腸吻合を行った．術後の経過は良好で11病日目に退院となった．胃切除Roux-Y再建術後に結石を伴う十二指腸憩室炎が発生した報告はなく，本邦初の症例と考えられた．腹腔鏡下手術を行い良好な結果を得たので報告する．

A 50-year-old woman with history of laparoscopic distal gastrectomy and Roux-en-Y reconstruction was referred to our hospital for admission with the complaint of upper abdominal pain. Abdominal computed tomography（CT） scan revealed a duodenal diverticulitis with enterolith, so we performed an emergency laparoscopic surgery. Duodenal diverticulitis with enteroliths was found at the side of the pancreas. We removed the enteroliths directly by duodenotomy without diverticulectomy because we didn't want the risk of a ruptured suture. Following laparoscopic duodenojejunostomy for improving the flow of duodenal fluid, she was discharged on POD11 after an uneventful postoperative course. This is the first case of a duodenal diverticulitis with enterolith after distal gastrectomy with Roux-en-Y reconstruction. We report our experience of successful laparoscopic surgry for duodenal diverticulitis.