急性壊疽性虫垂炎術後に発症した腸石を伴うメッケル憩室炎の1例

A case of Meckel's diverticulitis with enterolith following laparoscopic surgery for acute gangrenous appendicitis

◆要旨：患者は13歳，女児で，壊疽性虫垂炎穿孔に対して腹腔鏡下虫垂切除術を施行されたが，約3か月後，右下腹部痛を主訴に来院となった．白血球上昇を認め，CT上遺残糞石・膿瘍形成と診断した．保存的加療を行ったが炎症が増悪したため，糞石除去を目的に腹腔鏡下手術を行った．腹腔内を検索したが遺残糞石は認めず，回腸から連続した管状構造を認め，メッケル憩室と診断した．回腸は癒着により授動が困難であったため，メッケル憩室根部を自動縫合器で切離した．内部には腸石が存在し，病理診断でメッケル憩室炎と診断された．壊疽性虫垂炎後の腸石を伴うメッケル憩室炎は報告が少なく，文献的考察を加え報告する．

　We herein report a rare case of Meckel's diverticulitis with enterolith following acute gangrenous appendicitis. A 13-year-old woman who underwent laparoscopic surgery for perforated gangrenous appendicitis 3 months ago at our hospital was re-admitted because of a right lower abdominal pain and fever. An abdominal CT scan revealed a calcification with abscess formation in a pelvic cavity. The patient was operated on suspicion of a remnant appendiceal fecalith. However, during operation, there was no abscess in the pelvic cavity but a Meckel's diverticulum with an enterolith, and the diverticulum was resected with a linear stapler since the surroundings of the diverticulum were inflammatory and adhesive. The enteroliths were 8mm and 5mm in diameter, and no aberrant tissue was pathologically demonstrated in the diverticulum. 　Since the differential diagnosis between appendiceal fecalith and enterolith is difficult, intraoperative exploration of Meckel's diverticulum should also be performed in the case of gangrenous appendicitis.