腹腔鏡下スリーブ状胃切除術後に食道裂孔ヘルニアによる縦隔内胃管嵌入を呈し腹腔鏡下修復術を施行した1例

A case of intrathoracic sleeve migration treated with laparoscopic repair and gastric sleeve fixation

◆要旨：症例は59歳，女性．超重症肥満症に対して腹腔鏡下スリーブ状胃切除術を施行．手術から約1年後に腹痛・嘔吐症状をきたし，画像検査にてスリーブ胃管が縦隔内に嵌入しupside-down stomachを呈していたため，外科的介入が必要であると判断した．腹腔鏡下にスリーブ胃管を腹腔内に還納し，食道裂孔を縫縮，胃管固定を行った．術後の経過は良好で，約2年8か月経過現在まで再燃なく経過している．本病態はスリーブ状胃切除術後の合併症の中でも比較的稀であり，文献的考察も含め報告する．

　The case is a 59-year-old female. She underwent laparoscopic sleeve gastrectomy for morbid obesity. About one year after surgery, she developed abdominal pain and vomiting, and imaging studies showed that the gastric sleeve was migrated into the mediastinum（intrathoracic sleeve migration : ITSM） and presented an upside-down stomach, so we decided that surgical intervention was necessary. Operation was performed laparoscopically. The esophageal hiatal hernia was repaired, and the gastric tube was fixed to the mesentery of the transverse colon. The patient's postoperative course was good with no recurrence. ITSM presenting an upside-down stomach is a relatively rare complication after sleeve gastrectomy, and we report here with a review of the literature.