術前診断し腹腔鏡下手術が有用であった特発性小網捻転症の1例

Torsion of the lesser omentum treated by laparoscopic surgery

◆要旨：患者は40歳，男性．2日前より発熱，右季肋部痛を認め，前医より急性胆囊炎疑いで当院を紹介された．心窩部から右季肋部に著明な圧痛と，局所では腹膜刺激症状があり，造影CT検査で胃幽門前庭部頭側に内部に渦巻き状構造を伴う脂肪構造を認め小網捻転と診断され，同日腹腔鏡下で緊急手術を施行した．手術所見では胃幽門前庭部頭側腹側に大網に被覆され腫瘤状に捻転した小網を認め，小網捻転症と診断し切除を施行した．術後経過は良好で，術後6日目に退院となった．小網捻転症は非常に稀な疾患だが，造影CT検査で特徴的な所見を認めれば術前診断は可能で，腹腔鏡下手術は診断の確定および治療において低侵襲で有用であった．

A 40-year-old man was referred to our hospital with acute cholecystitis diagnosed based on pain in the right hypochondrium and fever. A fatty inflamed mass was found on abdominal enhanced CT between the posterior of the left hepatic lobe and prepyloric area of the stomach. Emergency surgery was performed laparoscopically based on the diagnosis of lesser omental torsion. Observation under laparoscopy revealed a twisted lesser omentum covered with the greater omentum. After releasing the omentum, the twisted lesser omentum was resected. The postoperative course was uneventful and the patient was discharged on the 6^th postoperative day. Torsion of the lesser omentum is a very rare disease ; however, preoperative diagnosis is possible if characteristic findings are confirmed on abdominal enhanced CT. Laparoscopic surgery was useful to confirm the diagnosis and for treatment of the lesser omentum torsion.