腹腔鏡下に摘出した遊走捻転脾の1例

Laparoscopic splenectomy for wandering spleen with torsion of the pedicle

◆要旨：患者は16歳，男性．臍周囲の間欠的な腹痛を主訴に当院を受診した．臍周囲に圧痛を認めたが，腹膜刺激症状は認めなかった．急性虫垂炎を疑い腹部超音波およびCTを施行したところ，脾梗塞と脾の位置異常を認め，遊走脾茎捻転の診断で緊急手術となった．手術は腹腔鏡下脾臓摘出術を行った．術中所見では遊走脾が左上腹部で脾動静脈を軸に反時計回りに180度回転していた．術後経過は良好であった．脾捻転は稀な疾患であるが，画像診断の発達によって，今後，術前に診断されうるケースが多いと思われる．このため，本病態の理解によって，緊急手術といえども，低侵襲，整容性，機能温存を念頭に置いた腹腔鏡下のアプローチは有用と思われた．

A 16-year-old male with no medical history visited our hospital complaining of intermittent periumbilical abdominal pain. The physical examination revealed periumbilical tenderness without peritoneal signs. At first, we suspected acute appendicitis, so abdominal US and contrast enhanced CT scans were performed. Imaging examinations revealed a splenic infarction and the absence of spleen in its normal position. Torsion of the splenic pedicle was diagnosed, and a laparoscopic splenectomy was performed successfully. At laparoscopy, the left upper quadrant was filled with wandering spleen which had twisted 180-degree counterclockwise rotations. No postoperative complication occurred. Torsion of wandering spleen is a rare clinical finding, but various imaging examination can help make the definitive diagnosis preoperatively. Therefore, depending on the understanding of this disease, even in emergency surgery, minimally invasive strategy should be considered for cosmetic and functional preservation.