十二指腸狭窄症状で発見され単孔式腹腔鏡下Ladd手術を施行した腸回転異常症の1例

Duodenal stenosis associated with intestinal malrotation treated by single incision laparoscopic Ladd's procedure

◆要旨：患者は36歳，男性．食後の腹痛と嘔吐を主訴に当院を受診した．腹部造影CT検査で胃と十二指腸の著明な拡張とSMV rotation signを認めた．上部消化管造影検査で十二指腸狭窄を認め，下部消化管造影検査では全大腸が左側に存在した．以上からLadd靱帯による十二指腸狭窄症状を伴ったnonrotation typeの腸回転異常症と診断し，単孔式腹腔鏡下Ladd手術を施行した．Ladd靭帯の切離，上腸間膜動脈基部の開放と虫垂切除を行い，腸管をnonrotationの状態として手術終了とした．単孔式腹腔鏡下Ladd手術は，多孔式手術で難渋する鏡映像操作がなく整容性を含めて有用な術式になりうると考えられた．

　A 36-year-old man visited our hospital with chief complaints of upper abdominal pain and vomiting. Enhanced CT examination revealed gastro-duodenal dilatation and SMV rotation sign. In addition, gastrointestinal contrast study revealed duodenal stenosis with caliber change and left-sided location of the colon. From these findings, nonrotation-type intestinal malrotation with duodenal stenosis owing to the ligament of Ladd was diagnosed. We performed single incision laparoscopic Ladd's procedure（SILLP）. We performed transection of the ligament of Ladd, widening the base of the superior mesenteric artery and appendectomy. Finally, the small intestine was arranged to right side, the colon to left side. In multiple-port laparoscopic Ladd's procedure, we often encounter mirror image which poses no problem during SILLP. Moreover, SILLP also has a cosmetic merit; therefore, it can be an alternative option for the patients without midgut volvulus.