腹腔鏡補助下に治療しえた腸管重複症に起因した穿孔性腹膜炎の1例

Perforative peritonitis due to adult intestinal duplication treated by laparoscope assisted surgery : a case report

◆要旨：患者は55歳，女性．前日より持続する下腹部痛を主訴に受診した．下腹部中心に筋性防御を伴う圧痛，反跳痛を認め，血液検査では炎症反応の上昇を認めた．腹部造影CTでは，下腹部ほぼ正中に周囲の脂肪織濃度の上昇を伴う腫瘤像を認め，Meckel憩室穿孔による急性腹膜炎の診断にて腹腔鏡下手術を施行した．虫垂に炎症所見は認めず．腹腔内には膿性腹水を多量に認め，回腸末端より約60cm口側の回腸腸間膜側に炎症を伴う腫瘤を認めたため，腫瘤を含む回腸部分切除術を施行した．病理組織検査では穿孔性腸管重複症の診断であった．成人腸管重複症，なかでも腹膜炎で発症するものは稀であり，その診断・治療に腹腔鏡は非常に有用であった．

　A 55-year-old woman presented with lower abdominal pain of 1-day duration. Palpation revealed severe lower abdominal tenderness with guarding and rebound tenderness. Laboratory data showed inflammation. Enhanced abdominal CT showed an inflammatory mass in the center of the lower abdomen; we diagnosed acute panperitonitis due to Meckel's diverticulum perforation and performed laparoscopic surgery. Laparoscopy showed normal appendix, and the presence of purulent ascites was confirmed. An inflammatory mass was confirmed on the mesentery side about 60 cm proximal from the ileum end; mass resection was performed with partial ileal resection. Histological examination indicated intestinal duplication with perforation. Intestinal duplication with peritonitis in adults is rare, and laparoscopic surgery is useful for the diagnosis and treatment of this condition.