腹腔鏡下手術で診断治療した虫垂捻転症の1例

A case of laparoscopic appendectomy for torsion of the vermiform appendix

◆要旨：患者は33歳，女性．右下腹部痛を主訴に当院救急外来を受診した．腹部触診で下腹部全体の圧痛，筋性防御を認め，腹部CT検査で骨盤内に腹水貯留，虫垂腫大を指摘された．急性虫垂炎穿孔による腹膜炎の診断にて腹腔鏡下での緊急手術を施行した．腹腔鏡にて腹腔内を観察すると，Douglas窩，右側腹部に白黄色の多量の腹水を認めた．虫垂の状態を検索すると，虫垂は非常に長く根部に炎症を認めなかったが，虫垂間膜が捻転し，捻転した部位より末梢側に血流障害をきたし，先端部に穿孔を認めた．虫垂軸捻転症による虫垂穿孔と診断し，虫垂切除術を施行した．肉眼的には捻転した部位より末梢側粘膜に暗赤色，浮腫状の循環障害による変化を認めた．病理組織所見はacute appendicitis, gangrenousであった．術経経過は良好であり第4病日に退院した．

　We report a case of laparoscopic appendectomy for torsion of the vermiform appendix. The patient was an 33-year-old woman complaining of lower abdominal pain. Abdominal palpation revealed tenderness in the lower abdomen with sign of muscle guarding. Abdominal computed tomography（CT） showed a swollen appendix with ascites. Based on these findings, diagnosis of acute general peritonitis due to acute appendicitis was made, and an emergent laparotomy was performed. At the laparotomy, the vermiform appendix showed 360 degree clockwise torsion at its root. An appendectomy was performed. On pathological examination, the appendix showed ischemic necrosis. The patient was discharged from the hospital 4 days after operation.