単孔式腹腔鏡下手術にて整復された原発性小腸軸捻転症の1例

Single-incision laparoscopic relieving of a primary small bowel volvulus : A case report

◆要旨：患者は92歳，男性．他疾患の精査中に嘔気，嘔吐，腹痛を認めたため精査を施行した．腹部理学所見では臍周囲に圧痛を認める程度であったが，腹部造影CT検査にて腸閉塞像とwhirl like patternが認められた．小腸軸捻転症と診断し，入院同日に単孔式腹腔鏡下手術を施行した．回腸は時計回りに180°捻転していた．腹腔鏡下に捻転を整復し，全小腸，腹腔内を観察した．先天的，後天的要因がないことを確認して，原発性小腸軸捻転症と診断した．術後経過は良好で，術後9日目に軽快退院となった．本邦では原発性小腸軸捻転症は稀な疾患であるが，単孔式腹腔鏡下手術を施行することでより低侵襲な治療ができると考えられた．

　A 92-year-old man visited our hospital. While his concern was orthopedic disorder, he complained of acute abdominal pain with nausea and vomiting during the examination. He showed a slight tenderness around the navel. A contrast computed tomography was performed and showed “whirl like pattern”, indicating rotation of small intestine and mesentery. We performed emergency surgery with the diagnosis of small intestinal volvulus employing the single-incision laparoscopic surgery. We found the small intestine twisting clockwise over 180°at the root of the mesenteric artery, without any lesions of ischemia. We were able to release the twisting to normal position with only laparoscopic technique. Since there was no sign predisposing to volvulus, we diagnosed it was primary small intestine volvulus. The postoperative course was favorable and he was discharge on day 9 after the operation. Reports of primary volvulus of the small intestine are very few in Japan ; besides there has been no report of a single-incision laparoscopic surgery for small intestinal volvulus. The single-incision laparoscopic technique may bring the less-invasive benefit in the patients with small intestinal volvulus