腹腔鏡下診断が有用であった虫垂炎に伴った大網捻転症の1例

A case of primary torsion of the greater omentum

◆要旨：患者は17歳，男性．右下腹部痛を主訴に当科を受診した．来院時，右下腹部に腹膜刺激症状を認め，CT検査で虫垂の軽度腫大，少量の腹水を認めた．血液検査で炎症所見は軽度であった．急性虫垂炎の診断で保存的治療を行ったが改善せず，2日後に手術を施行した．腹腔鏡下に腹腔内を観察すると，血性腹水を認め，正中右側よりの大網が捻転し，壊死に陥っていた．虫垂の炎症は軽度であった．以上の所見から，腹腔鏡下大網切除および虫垂切除術を施行した．特発性大網捻転の術前診断は，CT検査での特徴的な渦巻き状層状構造が典型的とされている．自験例のように典型的なCT像を呈さない症例では，診断・治療の行える腹腔鏡下手術は有用であると考えられた．

　A 17-year-old man visited the hospital complaining of right lower abdominal pain. Computed tomography （CT） showed swelling of the appendix vermiformis with fecal stones. He was diagnosed as having acute appendicitis and antibiotics were administered at first. As his symptoms and inflammatory response persisted, laparoscopic operation was done 2 days later. Dark red colored ascites was observed and torsion of the greater omentum was found. Therefore, the necrotic greater omentum was severed followed by an appendectomy under laparoscopy. The patient was discharged from the hospital on 5^th operative day. CT findings were not typical for torsion of the greater omentum in the present case, however, laparoscopic exploration was useful in treating such a case.