成人胃軸捻転症に対し腹腔鏡下胃固定術を施行した1例

A case of laparoscopic gastropexy for adult gastric volvulus

◆要旨：患者は67歳，女性．嘔気を主訴に救急を受診した．腹部単純CT検査にて，短軸性胃軸捻転症と診断された．保存的加療で軽快したため，いったん退院となった．退院翌日より腹部膨満と嘔気症状が再燃したため，当院を受診した．胃軸捻転症の再燃と診断され，胃管による減圧で症状は速やかに改善した．手術目的に当科を紹介され，腹腔鏡下胃固定術を施行した．手術時すでに捻転は解除されていた．胃底部と腹壁を3-0 PROLENEを用いて体内結紮で3針縫合固定した．経過良好で現在のところ再発は認めていない．短軸性胃軸捻転症に対し，腹腔鏡下胃固定術を施行した1例を経験したので若干の文献的考察を加え報告する．

A 67-year-old woman visited our emergency unit with a chief complaint of nausea. She was diagnosed as having short-axial gastric volvulus by plain abdominal computed tomography. Although endoscopic reduction was not applicable, there were no apparent findings of vascular insufficiency. Because abdominal symptoms were alleviated by decompression with a nasogastric tube, conservative therapy was continued. The following day, oral food intake was started. Because no relapse of abdominal symptoms was observed, she was discharged. One day after discharge, abdominal bloating and nausea relapsed, and she again visited our hospital. She was diagnosed as having relapse of gastric volvulus, and decompression with a nasogastric tube was applied. Immediate symptom relief was achieved. However, because her condition relapsed within a short period of time, she was referred to our department for surgery. Under the elective surgery policy, laparoscopic gastropexy was performed. Her volvulus had already become untwisted by the time of surgery. The gastric fornix and the abdominal wall were sutured with 3 stitches by internal ligation with 3-0 PROLENE suture. The postoperative course has been uneventful, and there has been no relapse to date. We report our experience with this case of laparoscopic gastropexy performed for short-axial gastric volvulus along with a brief literature review.