術前診断しえた副脾茎捻転に対して腹腔鏡手術を施行した1例

Preoperatively diagnosed torsion of an accessory spleen treated by laparoscopic surgery : A case report

◆要旨：症例は40歳台，男性．3日前から持続する左季肋部痛を主訴に救急外来を受診した．腹部造影CT検査にて，脾臓下極に直径約10mmの腫瘤影と，周囲の脂肪織の濃度上昇を認めた．腫瘤が副脾の位置として典型的であり，栄養血管が脾動脈から分岐していたことから副脾茎捻転と診断し，緊急手術を施行した．手術所見は，脾臓下極にうっ血壊死した大網を認めたため，大網を切除した．切除標本では，副脾への栄養血管を軸にして，大網が途中で捻転しており，その先に副脾を認めた．術後経過は良好であり，第2病日に退院した．副脾茎捻転は比較的稀な疾患であり術前診断が困難なことが多いため，急性腹症の鑑別疾患として考慮すべきである．

　A forties man presented to the emergency department with a chief complaint of pain in the left hypochondrium. Abdominalcontrast-enhanced CT revealed a mass measuring approximately 10mm in diameter at the lower aspect of the spleen, accompanied by an increased concentration of surrounding fatty tissue. The diagnosis of torsion of the accessory spleen was made based on its typical location as an accessory spleen and the feeding artery from the splenic artery. Emergency surgery was performed. Intraoperarive findings showed a congested and necrotic greater omentum at the lower side of the spleen, and the necrotic tissue was resected. Histopathological examination of the excised specimen confirmed the preoperative diagnosis of an accessory spleen. It was considered that the blood flow to the accessory spleen and the large omentum was disrupted by the torsion of the feeding artery. The postoperative course was good and the patient was discharged on the second day after surgery. Although preoperative diagnosis of torsion of an accessory spleen is often difficult, it should be considered in the differential disease of acute abdominal condition.