小児特発性腸間膜血腫に対し腹腔鏡下血腫除去術を施行した1例

Spontaneous mesenteric hematoma treated by laparoscopic resection in a child : A case report

◆要旨：症例は14歳，女児．背部痛の精査で撮影した腹部X線写真で，偶発的に石灰化を伴う腹部腫瘤を指摘された．CT，MRI所見から腸間膜血腫と診断され経過観察となったが，4年間の経過で緩徐な増大傾向を示した．悪性腫瘍が否定できないため，精査加療目的に当院入院となった．診断的治療として腹腔鏡下腫瘤摘出術を行った．腫瘤摘出時にはPfannenstiel切開を用いた．病理組織所見では悪性像のない血腫であり，特発性腸間膜血腫と診断した．術後は合併症なく経過し，術後第3病日に退院した．小児特発性腸間膜血腫に対する腹腔鏡下手術は，本症例が初めての報告である．

　The patient was a 14-year-old girl with an abdominal mass that was detected accidentally on an abdominal radiograph taken upon her clinic visit for back pain. As the mass was diagnosed as mesenteric hematoma using CT and MRI, she was followed up without operation. Because the mass gradually increased in size during her four years follow-up, she was referred to our hospital for surgical resection. She underwent laparoscopic tumor resection. A Pfannenstiel incision was used for the removal of the mass from the abdominal cavity. Histopathological findings confirmed a hematoma with no evidence of malignancy. Thus, the patient was diagnosed with spontaneous mesenteric hematoma. The postoperative course was uneventful and she was discharged on the third postoperative day. To the best of our knowledge, this is the first case of laparoscopic surgery for spontaneous mesenteric hematoma in a child.