傍卵巣囊胞捻転と卵管捻転を同時に伴った1例

A case of fallopian tube torsion with twisted para-ovarian cyst

◆要旨：傍卵巣囊胞捻転と卵管捻転を同時に伴った15歳女児の症例を報告する．患者は，腹痛を主訴に当科紹介となった．下腹部に圧痛，腹膜刺激症状を認めた．画像検査にて，骨盤内に大きさの違う2つの囊胞を認めた．腹腔鏡下手術を行い，術中所見にて左卵管は捻転し，腫瘤状に腫大していた．卵管に連続して，捻転した腫瘤を認めた．術前にみられた2つの囊胞は，捻転した傍卵巣囊胞と卵管の捻転により生じた卵管留水腫と考えられた．卵管ぎりぎりで囊胞壁を切除して断端を閉鎖し，卵管および卵管采はそのまま腹腔内に戻した．子宮付属器捻転に関しては，術前に画像診断することが困難なことが多く，腹腔鏡下手術は診断の確定および治療に有効である．

Fallopian tube torsion and twisted para-ovarian cysts are uncommon, but important causes of low abdominal pain in women. We present a case involving a 15-year-old girl who developed fallopian tube torsion with a twisted para-ovarian cyst. She complained of abdominal pain, but blood testing did not show any characteristic findings. The pre-operative radiologic examinations included abdominal ultrasonography, computed tomography, and magnetic resonance imaging, which showed double cysts in the pelvic cavity and suspected torsion of an ovarian cyst. The intra-operative findings revealed a twisted para-ovarian cyst and hydrosalpinx due to fallopian tube torsion. Extirpation of the left para-ovarian cyst was performed without a left salpingectomy. Laparoscopic surgery is recommended not only as a diagnostic procedure, but as a treatment strategy without complications for patients with uterine adnexal torsion.