成人特発性胃軸捻転症に対して腹腔鏡下胃固定術を施行した1例

A case of laparoscopic gastropexy for adult idiopathic gastric volvulus

◆要旨：患者は53歳，女性．統合失調症で入院中に嘔吐・腹痛を主訴に当院を受診し，画像所見から前方型短軸性胃軸捻転症と診断した．上部消化管内視鏡的に整復したが，4か月後に再発を認め，内視鏡的整復後に腹腔鏡下胃固定術を施行した．手術は3 ポートで行った．穹窿部の拡張伸展および胃幽門部の後腹膜への固定不良を認め，特発性と診断した．胃穹窿部から噴門部までの大彎側を横隔膜に3-0 V-Loc^TM180で連続縫合し，さらに逆V字状になるよう縫合開始点から胃大彎側を横隔膜，腹壁に縫合した．合併症はなく術後2日目に退院となり，術後1年の時点で再発は認めない．胃軸捻転に対して腹腔鏡下胃固定術を施行した1例を経験したので文献的考察を加えて報告する．

A 53-year-old female hospitalized elsewhere because of schizophrenia visited our hospital with principal complaints of vomiting and abdominal pain. An anterior short-axial gastric volvulus was evident on imaging; we repositioned the stomach via endoscopic detorsion. The volvulus recurred 4 months later and we performed laparoscopic surgery after endoscopic repositioning. Three ports were used. The gastric fornix extended to the greater curvature and the first portion of the duodenum was not fixed to the retroperitoneal portion. We used 3-0 V-Loc^TM 180 thread to suture from the gastric fornix to the lesser curvature of the diaphragm. In addition, we sutured the anterior wall of the stomach to the abdominal wall, from the gastric fornix to the greater curvature. The sutures thus formed a reverse-V. No complication or recurrence was observed, and the patient was discharged 2 days after operation. No recurrence has yet been noted, one year after surgery. We report our use of laparoscopic surgery to treat a gastric volvulus with literature review.