Upside-down stomachを呈する食道裂孔ヘルニアを合併した胃癌に対し腹腔鏡下噴門側胃切除，裂孔縫縮術を施行した1例

Laparoscopic proximal gastrectomy and esophageal hernia plication for gastric cancer associated with an upside-down stomach：A case report

◆要旨：Upside-down stomachを呈する食道裂孔ヘルニアを合併した胃癌に対し腹腔鏡下手術を行った症例の報告は少ない．患者は82歳，女性．繰り返す嘔吐による誤嚥性肺炎で入院中に上部消化管内視鏡検査にて胃癌を疑われ当科に紹介となった．上部消化管内視鏡検査では，胃の変形は非常に高度であり，噴門部に2型腫瘍を認めた．上部消化管造影検査では，胃軸捻転を伴った滑脱型食道裂孔ヘルニアによりupside-down stomachを呈していた．患者のADL，全身状態などから縮小手術の方針とし，腹腔鏡下噴門側胃切除術，食道裂孔縫縮術を施行した．術後の経過では嘔気，嘔吐などの症状の出現はなく経過し，術後16日目に転院となった．低侵襲な手術を行うことが可能であり，良好な結果を得られた．

　There have been few reports of laparoscopic surgery for gastric cancer accompanied by an esophageal hiatus with an upside-down stomach. An 82-year-old woman was referred to our department while hospitalized for aspiration pneumonitis due to recurrent vomiting. Upper gastrointestinal endoscopy findings suggested gastric cancer with severe deformation of the stomach and a type 2 tumor in the cardia. Radiography revealed an upside-down stomach caused by a sliding hiatal hernia accompanied by stomach volvulus. Considering the patient's activities of daily living and general status, reduction surgery was indicated. Laparoscopic proximal gastrectomy and esophageal hernia plication were performed. Postoperative course was uneventful and there were no complications of nausea or vomiting. She was transferred on postoperative day 16. The present patient was successfully treated with minimally invasive surgery, resulting in a favorable outcome.