腸回転異常症例における穿孔性虫垂炎に対して腹腔鏡補助下切除を施行した1例

A case of perforated appendicitis with intestinal malrotation treated by laparoscopy-assisted appendectomy

◆要旨：患者は61歳，女性．下腹部痛を主訴に近医を受診した．上部消化管内視鏡検査，婦人科的検査を行ったが異常所見はなく，しかし症状の改善がないため当院を紹介され受診した．CTで上腸間膜静脈（SMV）が上腸間膜動脈（SMA）の左側に位置するSMV rotation signを認め，腹部正中を走行する上行結腸と骨盤内に膿瘍形成を認めた．以上より腸回転異常症における穿孔性虫垂炎と診断し，腹腔鏡下に虫垂切除，ドレナージ術を行った．術後経過は良好で第9病日に退院した．腸回転異常症は成人では無症状の場合，検査や手術時に偶然発見される稀な疾患である．今回，腸回転異常症における穿孔性虫垂炎に，腹腔鏡下手術を施行しえた1例を経験したので報告する．

A 61-year-old female visited her family doctor with a complaint of lower abdominal pain. No abnormal findings were revealed with upper gastrointestinal endoscopy and gynecological examination, however, without improvement in her symptoms, she was referred to our hospital. Abdominal multidetector-row computed tomography （MDCT） revealed a SMV rotation sign where superior mesenteric artery （SMA） was running along the right side of superior mesenteric vein （SMV）, ascending colon and terminal ileum located at the mid-lower abdomen, and the presence of abscess formation in the pelvic cavity. Upon diagnosis of perforated appendicitis with intestinal malrotation, emergency laparoscopic appendectomy and drainage was performed. The patient was discharged on day 9 with satisfactory postoperative progress. Intestinal malrotation is a rare disease usually discovered accidentally at the time of examination or emergency operation, in asymptomatic in adult cases. We report a case of perforated appendicitis with intestinal malrotation treated by laparoscopic appendectomy.