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軸捻転を伴う腸回転異常症の9歳,男児例に対して,腹腔鏡下Ladd手術を施行した.時計方向に360度の軸捻転が認められ,十二指腸を巻き込んでいた.まず盲腸を起点として小腸を順にたぐり捻転を解除し,その後,十二指腸から順に遠位側に腸管をたぐり局所の捻転解除操作を続けていき,軸捻転の解除を完了した.その後,Ladd靱帯を切離し腸間膜根部の拡幅による軸の解除を行い,臍部創を用いて体外法にて虫垂切除を行った.血行障害をきたしていない症例では,軸捻転を伴っていても腹腔鏡下Ladd手術の適応となりうると考えられる.
Laparoscopic repair of volvulus and Ladd's operation was performed for a 9-year-old boy diagnosed as hav-ing intestinal malrotation complicated by midgut volvulus. The midgut showed a 360°clockwise rotation and the duodenum was wrapped in the volvulus. At first, small intestinal loop was traced and derotated proximally from the cecum to the duodenum. Thereafter the duodenum was recognized, and the bowel was re-traced and exam-ined distally in a stepwize fashion, ensuring there are not residual twists.
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