腹腔鏡下で治療しえた小腸型Chilaiditi症候群の1例

A case of small intestine type Chilaiditi syndrome treated with laparoscopic surgery

◆要旨：患者は84歳，女性．悪心・嘔吐に対し近医にて対症療法を受けていたが改善がなく，当院の消化器内科を紹介され受診した．精査の結果，小腸型のChilaiditi症候群に伴う腸閉塞と診断され，イレウス管留置により保存加療を施行した．腹部症状は改善したものの腸閉塞の解除には至らず，手術加療を目的に当科を紹介され，第7病日に腹腔鏡下腸閉塞解除術を施行した．腸管虚血は認めず，腸管切除は不要であった．術後経過は良好で術後6日目に退院した．小腸型のChilaiditi症候群は稀であり，絞扼性腸閉塞をきたすこともあるとされているが，術前診断し減圧処置を先行させることにより腹腔鏡下にて治療しえた1例を経験したので報告する．

　An 84-year-old woman was referred to our institute after being treated for nausea and vomiting at a nearby clinic. After various examinations, the patient was diagnosed as having intestinal obstruction accompanied by small intestine type Chilaiditi syndrome and conservative treatment was performed by placing long intestinal tube. Although abdominal symptoms improved, intestinal obstruction continued. On day 7 of the disease, we performed laparoscopic surgery to release the intestinal obstruction. The stenosis of the small intestine occurred due to strangulation of the liver surface. The strangulation was cut off and intestinal obstruction was released. Because there was no ischemia, intestinal resection was unnecessary. The patient was discharged on postoperative day 6. Chilaiditi syndrome of the small intestine type is rare and may lead to strangulated intestinal obstruction. In many of the previous reports, open surgery was performed to release the intestinal obstruction. We experienced a case which could be treated laparoscopically by preoperative diagnosis and decompression treatment. The case is discussed with literature review.