小網裂孔に胃体部が嵌入して発症した胃長軸捻転症に対し腹腔鏡下整復胃固定術を施行した1例

Laparoscopic gastropexy treated with adult gastric volvulus with lesser omental hernia : A case report

◆要旨：患者は69歳，女性．嘔気を主訴に近医受診し，腹部単純X線で著明な胃拡張を認めた．精査目的に当院紹介受診となり腹部造影CT検査にて胃軸捻転が疑われた．内視鏡での整復は困難であったため，手術目的に当科紹介となった．腹腔鏡下に腹腔内を検索したところ，胃が背側に向かって長軸方向に捻転し，胃体部が小網にできた裂孔に陥入して内ヘルニアを呈していた．腹腔鏡操作のまま陥入，捻転を解除したのち，小網裂孔を体内結紮で閉鎖し，胃体部と左上腹部壁側腹膜を体内結紮で縫合固定した．術後経過良好で退院後も再発は認めていない．小網裂孔に胃体部が陥入して発症した胃長軸捻転症は本邦初の報告となる．

A 69-year-old woman visited a local clinic complaining of nausea and vomiting. Abdominal X-ray film revealed a markedly dilated stomach and she was referred to our hospital on an ambulance for scrutiny. She was diagnosed as probable gastric volvulus around longitudinal axis by abdominal computed tomography. Because reposition of the torsion using a gastroscopy was not successful, she was referred to our department for surgical treatment. A substantial defect of the lesser omentum was identified by laparoscopic exploration. We found that the gastric body protruded through the defect of the lesser omentum resulting in 360° rotation at longitudinal axis. After successful reposition, the defect of the lesser omentum was closed and gastropexy was accomplished by placing interrupted sutures between gastric body and lateral abdominal wall. The postoperative course was uneventful, and she has been in good health without any sign of recurrence after discharge. We reported the first case of gastric volvulus with longitudinal axis torsion accompanied by lesser omental hernia, treated successfully with laparoscopic operation in Japan.