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◆要旨：患者は66歳，男性．腹痛を主訴に救急搬送となった．腹部は硬く，反跳痛を認め，腹部CT検査で限局性の小腸の拡張，腹水を認めた．食事歴から小腸アニサキス症を疑いつつも，腹部所見，CT所見から絞扼性腸閉塞との鑑別が困難であり，単孔式審査腹腔鏡を施行した．手術所見では漿液性腹水，小腸の限局した拡張を認めたが，血流異常や捻転は認めず，小腸アニサキス症を疑い観察のみで手術を終了した．術後経過は良好で，腹部所見はすみやかに改善した．抗アニサキス抗体の上昇を認め，小腸アニサキス症と診断した．小腸アニサキス症は急性腹症の鑑別診断として重要であり，治療・診断には単孔式審査腹腔鏡は有用な選択肢と考えられた．
We report a 66-year-old man who was diagnosed with small intestinal anisakiasis which was successfully identified by a single-incision exploratory laparoscopy. He was admitted to our hospital with sudden abdominal pain two days after eating raw fish. He exhibited tenderness in the umbilical region with rebound tenderness and muscular rigidity. Computer tomography (CT) demonstrated swollen partial segment of the small bowel with signs of inflammation, and intestinal dilatation with fluid collection on the oral side of the lesion. Because anisakiasis was suspected based on the patient's history of recent raw fish consumption and abdominal CT findings, we performed an emergency exploratory laparoscopy with a single-port approach. Clear ascites was noted in the peritoneal cavity. The serous surface of the jejunum showed redness and annular edema, causing dilatation of the proximal side of the intestine. No strangulated change or volvulus was found throughout the entire small bowel. From these findings, the patient was diagnosed with small intestine anisakiasis and conservative therapy was performed, without resecting the small intestinal lesion. The abdominal symptoms were relieved immediately and the patient was discharged on the fifth hospital day. Anti-anisakiasis antibody in serum was detected and small intestinal anisakiasis was finally diagnosed. Small intestinal anisakiasis should be considered in the differential diagnosis of acute abdomen. Single-incision exploratory laparoscopy is useful as a diagnostic tool and minimally invasive treatment.
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