遺残虫垂炎に対し腹腔鏡下盲腸楔状切除術を施行した1例

Laparoscopic partial cecal resection for stump appendicitis : a case report

◆要旨：患者は61歳，女性．47年前に急性虫垂炎に対し虫垂切除術が施行されている．2011年5月に2か月前より断続的に認めていた右腰背部違和感に加え，右下腹部痛および嘔吐も併発したため当院を受診した．受診時にMcBurney点を最強とする腹部全体の圧痛を認めた．腹部CTで盲腸の尾側内側に径10mmの管腔臓器を認め，内腔に糞石様所見を認めた．血液検査では軽度の炎症所見亢進を認めた．尿路結石，婦人科疾患，および神経学的要因を否定できたため遺残虫垂炎と診断し，盲腸楔状切除術を施行した．切除標本で粘膜面の軽度うっ血を認め，病理組織学的に高度の慢性炎症像を認めた．術後経過良好で，術後3日目に退院となった．

　The patient was a 61-year-old female who was referred to our hospital because of right lower abdominal pain and nausea with right lumbago that had persisted for 2 months. Her past history revealed that she had undergone appendectomy for acute appendicitis, 47 years ago. Physical examination showed diffuse abdominal tenderness that reached a maximum at McBurney's point. Abdominal computed tomography showed calcification, indicating the presence of a fecal stone within a short tubular structure of 10 mm in diameter at the caput cecum. Laboratory data showed slight elevation of the white blood cell count and serum C-reactive protein level. A preoperative diagnosis of stump appendicitis was made after exclusion of urinary stone, gynecological diseases, and neurologic diseases. Laparoscopic partial cecal resection with the stump appendix was performed. The resected specimen revealed slight congestion of the mucosa. A histological examination showed chronic inflammation of the stump appendix. The patient was discharged 3 days after the operation.