十二指腸潰瘍穿孔に対する腹腔鏡下肝円索充塡被覆術の1例

Laparoscopic use of hepatic round ligament patch for duodenal perforation

　患者は63歳，男性．上腹部痛を主訴に来院した．胸部X線写真，胸部CTで遊離ガス像を認めた．上部消化管内視鏡を施行し，十二指腸球部前壁に潰瘍を認めたが狭窄はなかった．十二指腸潰瘍穿孔性腹膜炎と診断し，腹腔鏡下大網被覆術を予定し手術を行った．しかし大網が炎症で短縮していたため使用できず，肝円索を用い，穿孔部を充塡被覆した．手術時間は152分，出血量は少量であった．術後経過は順調で，術後20日目に退院した．腹腔鏡下十二指腸潰瘍穿孔閉鎖術において大網が使用できない場合，肝円索を利用することは有用な方法と考えられた．

A 63-year-old male came to our hospital because of an upper abdominal pain. A chest radiograph and chest computed tomography showed free air in the peritoneal cavity. Endoscopic examination revealed, an ulcer with-out stenosis in the anterior wall of the duodenum. The diagnosis of duodenal ulcer with peritonitis was made and treatment of this perforation using large omental patch laparoscopically was planned. However, since the large omentum was too short owing to inflammation, hepatic round ligament was used as patch.