腹腔鏡下に切除し得た特発性大網捻転症の1例

A Case of Laparoscopic Resection for Primary Omental Torsion

　腹腔鏡下に切除し得た特発性大網捻転症の1例を経験したので報告する．症例は56歳男性で，右腹部痛を主訴に来院した．同部に圧痛と筋性防御反応を認め，腹部単純X線写真では，右下腹部に15×7cm大の腫瘤様陰影と小腸鏡面像を，血液検査では白血球数の増多を認めた．急性腹症の診断にて腹腔鏡下に検索を行ったところ，右側の大網が暗紫色に変色し，近位側で捻転を認めた．特発性大網捻転と確診し，引き続き捻転大網を切除した．経過は良好で術後9日目に退院した．本症は稀な疾患で，しかも術前診断が困難なため，これまですべての例に緊急開腹手術が施行されてきた．しかし，本例のごとく腹腔鏡下に検索を行えば，確診を得て，引き続き切除も可能である．腹腔鏡は本症の確定診断，治療にきわめて有用と考えられた．

A 56-year-old man was referred to our hospital with a complaint of tenderness and defense of the right lower abdomen. The abdominal X-ray revealed a 15 x 7 cm tumor. Hematological test showed leucocytosis. An emergency laparoscopic operation was performed under a diagnosis of acute abdomen. Laparoscopic examination demonstrated a dark-red colored mass, found in the right side of the omentum, and torsion of greater omentum in the proximal side. The operative diagnosis was primary torsion of the greater omentum and the twisted omentum was resected. The postoperative course was uneventful.