虫垂炎術後70年経過して発症した盲腸皮膚瘻に対して腹腔鏡下盲腸部分切除術を施行した1例

A case of cecocutaneous fistula seventy years after appendectomy

◆要旨：虫垂炎術後70年経過して発症した盲腸皮膚瘻に対して腹腔鏡下盲腸部分切除術を施行し，治療しえたので報告する．患者は90歳，男性．20歳の時に開腹虫垂切除術を施行された．70年経過し，右下腹部の手術痕から便汁様排液を認めたため，当院を紹介され受診した．CT検査で創直下の腹壁欠損を認め，同部位に盲腸が瘻孔を形成し，盲腸皮膚瘻と診断した．腹腔鏡下の観察で，ヘルニア門に盲腸と大網の一部がはまり込み，癒着していたため，剝離した．続いて手術痕を取り除く形で皮切を置き，腹腔鏡で施行した剝離層に繋げて盲腸を遊離した．皮膚と瘻孔と一塊になった盲腸の部分切除を行った．腸管皮膚瘻に対する腹腔鏡下手術は，正確な病態把握と低侵襲治療に有用である．

　The patient was a 90-year-old man who had undergone an open appendectomy at the age of 20. Computed tomography （CT） revealed an abdominal wall defect directly under the wound, with a fistula in the cecum at the same site. Therefore, a diagnosis of cecocutaneous fistula was made. Laparoscopy indicated that a part of the cecum and omentum were caught in the hernial orifice, forming adhesion, and were dissected. Subsequently, skin incision was made to remove the surgical scarring ; the stratum disjunctum was connected to the cecum and was freed laparoscopically. The cecum, which formed a mass with the skin and fistula, was partially resected. We believe that laparoscopic surgery for cecocutaneous fistulas is a minimally invasive approach that can be used for accurate diagnosis and treatment.