成人腸回転異常症を合併した盲腸癌に対し腹腔鏡補助下回盲部切除術を施行した1例

Colon cancer with adult intestinal malrotation treated with laparoscopy-assisted surgery : a case report

◆要旨：患者は73歳，女性．腹部膨満感を主訴に近医を受診した．大腸内視鏡検査でS状結腸まで異常はなかったが，下行結腸より口側の観察は困難であった．注腸造影検査で腹部中央に上行結腸を，盲腸に隆起性病変を認め，成人腸回転異常症を合併した盲腸癌を疑われ当院を紹介された．腹部CT検査でSMV rotation signを認め，盲腸に約3cm大の腫瘤を認めた．陽電子放射断層撮影（PET）-CTで同部位にSUV 4.8（delay 6.7）の集積を認めた．リンパ節転移や遠隔転移は認めなかった．成人腸回転異常症を合併した盲腸癌を強く疑い，腹腔鏡補助下回盲部切除術を施行した．組織診断は高分化型腺癌，m，n0，stage 0であった．術後経過は順調で，術後8日目に退院となった．若干の文献的考察を加えて報告する．

We report a case of colon cancer with adult intestinal malrotation treated with laparoscopy-assisted surgery, with reference to the literature. A 73-year-old female visited a family clinic with a complaint of abdominal distension. Barium enema showed a cecal tumor with intestinal malrotation, but the tumor was not detected on colonoscopy. The patient was referred to our hospital for suspected cecal cancer with intestinal malrotation. Abdominal computed tomography（CT） showed the superior mesenteric vein（SMV） rotation sign and a cecal tumor. Positron emission tomography（PET）-CT showed a high standardized uptake value（SUV） in the cecum but no lymph node or distant metastasis. The patient underwent laparoscopy-assisted surgery for cecal cancer with intestinal malrotation. Her postoperative course was uneventful, and she was discharged from our hospital eight days after the operation.