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◆要旨:近年,遊走脾を伴う胃軸捻転に対する腹腔鏡下脾・胃固定術の報告が散見される.今回,腹腔鏡下3ポートによるretroperitoneal pouch法で脾・胃固定術を行ったので報告する.患者は4歳,女児.急性胃軸捻転の診断で1年3か月前に前医で開腹胃固定術を施行され,同入院中にMarfan症候群と診断された.1年後に再発し,保存的に軽快したが,以後も反復するため当科紹介となった.胃軸捻転時のCT画像から遊走脾を伴うと判断し,腹腔鏡下脾・胃固定術を行った.フレキシブルエネルギーデバイスを用い,3ポートretroperitoneal pouch法を安全に施行しえた.術後経過良好で,3日目に退院となった.遊走脾を伴う反復性胃軸捻転にフレキシブルデバイスを用いた腹腔鏡下脾・胃固定術は有用と考えられた.
Recently, there are some reports about laparoscopic splenopexy for wandering spleen associated with gastric volvulus in children in the literature. We experienced a case of a recurrent gastric volvulus with wandering spleen and Marfan syndrome. She had open gastropexy in the previous hospital one year and three months ago. At one year after the operation, gastric volvulus was recurred. We utilized a laparoscopic splenopexy and gastropexy for wandering spleen and recurrent gastric volvulus following a retroperitoneal pouch procedure with 3 ports using a flexible energy device. Postoperatively, the patient was doing well and discharged after postoperative day 3. We conclude that laparoscopic splenopexy and gastropexy following a retroperitoneal pouch procedure with 3 ports using a flexible energy device was safe and feasible for wandering spleen associated with gastric volvulus.
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