脊柱側彎症に併発した上腸間膜動脈症候群に対し腹腔鏡下十二指腸空腸吻合術を行った1例

Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome with scoliosis：A case report

◆要旨：患者は18歳，男性．高度な側彎を伴っていた．嘔吐を主訴に来院し，CT検査・上部消化管造影にて上腸間膜動脈症候群（superior mesenteric artery ; SMA症候群）と診断した．保存療法では再発を繰り返すため手術の方針とした．腹腔鏡下でTreitz靱帯から20cmの空腸を切離し，Roux-en-Y法で再建した．2か所の吻合は自動縫合器で行い，挿入孔は腹腔内で縫合した．術後7日目には固形物摂取が可能となり合併症なく退院した．SMA症候群に対する低侵襲手術として腹腔鏡下十二指腸空腸吻合術の報告は増えているが，脊柱側彎症という脊柱変形が背景にあっても安全に施行可能であった．

　An 18-year-old man with a history of scoliosis presented with persistent vomiting. Abdominal computed tomography and upper gastrointestinal series confirmed a diagnosis of superior mesenteric artery （SMA） syndrome. Conservative treatment was ineffective; therefore, we performed laparoscopic bypass surgery. A jejunal incision was made 20 cm distal to the ligament of Treitz, and Roux-en-Y reconstruction was performed. We performed two anastomoses using endoscopic linear stapler and closed the entry of stapler intra-abdominally. Solid food was resumed on postoperative day 7, and the patient was discharged without any complications. Laparoscopic duodenojejunostomy is a safe and useful minimally invasive approach to treat SMA syndrome in patients with an abnormal habitus associated with scoliosis.