腹腔鏡補助下に最終診断し治療したMeckel憩室の1例

A case of ileus caused by Meckel diverticulum which was successfully diagnosed and treated by laparoscopic assisted surgery

◆要旨：患者は手術既往のない26歳，男性．主訴は腹痛．腹部X線・腹部CT検査でMeckel憩室，イレウスの疑いにて入院となった．初回入院はイレウス管にて速やかに減圧し，本人の都合で退院となったが，6か月後にも同様の症状で入院した．イレウス管を挿入して減圧後，1か月間待機した後に内視鏡補助下に根治手術を行った．手術所見でBauhin弁から60cmの回腸にT字型に突出した囊状構造物を認め，Meckel憩室と診断した．臍背側の癒着を剝離し，ポート挿入孔より腹腔外に誘導して切除した．腸管の拡張はなく，Treitz靱帯から回盲弁まで行い，他の腸閉塞の原因がないことを十分に確認したうえで安全に手術を終了し得た．

　A 26-year-old man with no history of abdominal surgery was brought into Oomachi Municipal Hospital complaining of acute abdominal pain. Abdominal computed tomography revealed distal small bowel obstruction. We also suspected Meckel's diverticulum from abdominal CT. After a long tube was inserted, abdominal symptoms improved and he was discharged. Six months after the first treatment, he was admitted to our hospital due to the same symptom. A ileus tube was inserted again and small bowel obstruction was released. This time, to diagnose the cause of bowel obstruction and treat the disorder, laparoscopic surgery was performed. Using endoscopic bowel forceps, the cause of the obstruction was explored. Laparoscopic exploration revealed that a Meckel diverticulum was tightly attached to the abdominal wall near the umbilicus. After removal from the abdominal wall, resection of the Meckel diverticulum with a suturing instrument was performed. Postoparetive course was uneventful and fast. Laparoscopic procedures are useful in not only identifying causes of bowel obstruction but also treating it safety.