Persistent descending mesocolonに伴う内ヘルニアを合併した完全内臓逆位の1例

A case of situs inversus totalis with internal hernia due to persistent descending mesocolon

◆要旨：患者は65歳，男性．以前より完全内臓逆位を指摘されていた．腹部膨満感，右下腹部圧痛を主訴に当科を受診した．腹部CT検査にて回盲部近傍の回腸に狭窄および口側腸管の著明な拡張を認め，腸閉塞と診断した．イレウス管を挿入し保存的治療を行ったが改善に乏しく手術の方針となった．手術は腹腔鏡下に施行した．下行結腸と後腹膜との固定がされておらず，persistent descending mesocolonと診断した．S状結腸間膜と回腸末端付近の小腸間膜に癒着を認め，癒着により生じた間隙をヘルニア門とし小腸が嵌頓し内ヘルニアをきたしていた．内ヘルニアを解除し，ヘルニア門となった癒着の剝離を行った．現在再発なく経過している．

　A 65-year-old man, who was diagnosed as situs inversus totalis, presented to our department because of abdominal distension and right lower abdominal pain. Abdominal CT scan revealed stenosis of ileum in the vicinity of ileocecum and oral-side intestinal dilatation. We made a diagnosis of intestinal obstruction but conservative treatment by long intestinal tube could not improve the symptoms, therefore, we planned laparoscopic operation. We found the descending colon was not fused with the retroperitoneum and diagnosed as persistent descending mesocolon. Adhesion between the sigmoid colon mesentery and the ileal mesentery in the vicinity of the ileocecum was revealed and a segment of ileum had herniated into the space formed by adhesion. We pulled back the ileum and released the adhesion. He is currently doing well without recurrence.