腹腔鏡下Ladd手術を行った小腸部分捻転をきたした成人腸回転異常症の1例

A case report of partial small intestinal volvulus associated with intestinal malrotation in an adult treated by laparoscopic Ladd's procedure

◆要旨：稀な成人腸回転異常症に対し，腹腔鏡下に治療し得た症例を報告する．症例は30歳代女性，幼少期からの腹痛の精査，加療目的に当科紹介となった．精査によりnon-rotation typeの腸回転異常症と診断し，腹腔鏡下Ladd手術を行った．腹腔内には膜状のLadd靱帯がかかり，これがヘルニア囊のようになり一部小腸が反時計回りに捻転しつつ嵌入していた．捻転を解除しLadd靱帯を切離して腸管を並べ直して手術を終了した．術後8か月間の症状再燃はない．多彩な病態を示す腸回転異常症において，腹腔鏡手術は正確な術中診断ができ，かつ低侵襲治療としても有用と考えられる．

　Intestinal malrotation is rare in adults. We report a patient with partial small intestinal volvulus due to ligament of Ladd which was successfully treated by laparoscopy. A woman in her thirties visited our hospital with chronic abdominal pain since childhood. Careful examinations showed non-rotation type intestinal malrotation as the cause of her chief complaint. We performed laparoscopic Ladd's procedure. In the abdominal cavity, ligament of Ladd has covered part of the small intestine, creating a hernia-like sac and causing partial small intestinal volvulus counterclockwise. After this volvulus was released, the ligament of Ladd was dissected and the intestines was rearranged. After surgery, the abdominal pain improved and there had been no recurrence for 8 months. Laparoscopic surgery can be used for not only accurate diagnostic tool for intestinal malrotation showing various pathological conditions, but also minimally invasive treatment.