間欠的腹痛を呈した成人腸回転異常症に対し腹腔鏡下整復術を施行した1例

A case of adult intestinal malrotation presenting with intermittent abdominal pain treated by laparoscopic correction

◆要旨：症例は38歳，男性．急性虫垂炎術後半年から間欠的な腹痛が出現し，徐々に増悪傾向となって当院を受診した．CTで腸回転異常症および中腸軸捻転が指摘され，各種検査で腸管走行を評価したところ横行結腸の一部に通過不良域を認めた．腹痛の原因と診断し，腹腔鏡下での手術加療の方針となった．術中Treitz靱帯の不完全形成および上行結腸と後腹膜の癒合不全を認め，小腸から横行結腸にかけて上腸間膜動脈を中心に反時計回りに360度捻転していた．これを正常位に整復し，腸管を固定して手術を終了した．術後十二指腸の屈曲が残存し一時的に嘔気嘔吐を呈したが，保存的加療後に改善した．非常に稀な1例を経験したため報告する．

　A 38-year-old man visited our hospital due to intermittent abdominal pain that began six months after appendectomy, which gradually worsened. Computed tomography revealed intestinal malrotation and midgut volvulus. Various examinations of intestinal anatomy identified a segment of the transverse colon with impaired passage which was determined to be the cause of the abdominal pain, and laparoscopic surgery was performed. Failure of fusion between the ascending colon and the retroperitoneum was detected, and the small intestine and transverse colon were found to have rotated 360 degrees counterclockwise around the superior mesenteric artery. Surgery was completed by restoring the intestines to their normal positions and attaching the ascending colon to the retroperitoneum. Although the patient initially experienced nausea and vomiting due to residual duodenal kinking, the condition was resolved by conservative management. Herein, we report this very rare case of adult intestinal malrotation.