腹腔鏡にて診断，治療しえたMeckel憩室捻転の1例

A case of Meckel's diverticulum torsion diagnosed and treated by laparoscopic surgery

◆要旨：患者は39歳，男性．幼少時に虫垂炎の手術を施行されていた．8年前より時々右下腹部痛を認めていた．5日前から次第に増強する右下腹部痛を主訴に当院を受診した．白血球の増多を認め，右下腹部に著明な圧痛と反跳痛を認めた．腹部CT検査にて右下腹部に囊状病変を認めた．Meckel憩室の捻転が鑑別診断として挙げられたが，確定診断には至らなかった．腹膜刺激症状も認めたため，同日，緊急手術を行った．腹腔鏡下に腹腔内を観察すると，回腸末端から約60cm口側の回腸に径8cmの憩室が存在し，頸部で捻転し，憩室周囲の癒着を認めた．腹腔鏡下に憩室周囲の癒着を剝離し，小開腹下で，憩室を含め小腸部分切除術を行った．病理結果では異所性組織は認めず，術後経過は良好で，術後13日目に退院となった．原因不明の急性腹症では，Meckel憩室の関与を念頭に置くべきであり，その診断，治療に際しては腹腔鏡が有用であると考えられた．

A 39-year-old man had undergone appendectomy for acute appendicitis in his childhood. He had sometimes felt right lower abdominal pain from eight years ago. He was admitted to the hospital because of increasing right lower abdominal pain from five days ago. Laboratory tests showed increase of white cell count, and his abdomen was distended and there were muscle guarding, severe tenderness, and Blumberg's sign. Abdominal CT scan revealed a cystic lesion. An emergency operation was performed under a diagnosis of peritonitis. Laparoscopic findings showed that the Meckel's diverticulum, 8cm in size, located in the ileum about 60cm proximal from the terminal ileum was twisted at its neck, and had adhered around the diverticulum. Adhesion was dissected and partial resection of the ileum including Meckel's diverticulum was performed. No findings of ectopic gastric mucosa were seen. Postoperative course was uneventful and he was discharged from the hospital on the 13th hospital day.　Meckel's diverticulum must be kept in mind in patients with acute abdomen of unknown origin. Laparoscopy is beneficial for diagnosis and is less invasive than conventional surgery when Meckel's diverticulum is suspected.