腹腔鏡下手術が有用であった大網捻転症の2例

Two cases of greater omental torsion treated laparoscopically

◆要旨：発生機序の異なる2例の大網捻転症を経験した．症例1は60歳，男性．右鼠径ヘルニアに合併した大網捻転症の診断のもと，緊急で腹膜外腔アプローチによる腹腔鏡下鼠径ヘルニア根治術を施行し，続いて一期的に腹腔鏡下に捻転大網切除術を施行した．症例2は38歳，女性．突然の右下腹部痛を主訴に来院した．術前画像にて骨盤内に脂肪性腫瘤を認めた．強い腹膜刺激症状を伴い，腹腔鏡下に緊急手術を行った．術中，大網腫瘤捻転による大網捻転症と判断し，大網腫瘤摘出術を施行した．腫瘤は線維性被膜で覆われ，内部には脂肪組織，出血を認め，組織学的には変性した大網組織であった．いずれも腹腔鏡下手術が診断，治療において低侵襲で有用であった．

　We report two cases of greater omental torsion treated laparoscopically. Case 1 : A 60-year-old man was admitted to our hospital with lower right abdominal pain. Emergency operation was performed based on the diagnosis of omental torsion caused by right inguinal hernia. Laparoscopic repair of the right inguinal hernia by the extraperitoneal approach and laparoscopic resection of the necrotic omentum were performed at once. Case 2 : A 38-year-old woman was admitted to our hospital with sudden lower right abdominal pain. Abdominal CT showed the fatty mass with turbid fat tissue in the pelvic cavity. She had strong peritoneal irritation in the lower abdomen. Emergency operation was performed laparoscopically. Laparoscopy revealed the omental torsion caused by a tumor of the omentum with a smooth surface. Tumor excision and partial omentectomy was performed to treat the torsion. Macroscopically, the tumor had a hard fibrous capsule outside and adipose tissue and bleeding inside. Histopathological findings revealed degenerated omental tissue. We concluded that laparoscopic surgery was effective in diagnosis and treatment for patients with acute abdominal symptoms.