盲腸壊死に対して腹腔鏡下回盲部切除術を行った1例

A case of isolated cecal necrosis treated with laparoscopic ileocecal resection

◆要旨：非常に稀な盲腸に限局した腸管壊死を経験したため報告する．症例は61歳の女性で，前日からの右下腹部痛のために当院を受診した．急性虫垂炎と診断し，腹部症状が強かったため同日緊急手術を行った．肉眼的に虫垂は正常で，盲腸を中心とした虚血壊死を認めた．盲腸壊死と診断し，腹腔鏡下回盲部切除術を行い，術後22日目に自宅退院した．大腸で虚血を起こしやすい領域は脾彎曲部やSudeck's critical pointであるが，右側結腸でも虚血性腸炎を起こすことがあり，その場合は壊死型が多いと報告されている．血管リスクを伴う右下腹部痛では虚血性腸炎を鑑別に入れるべきであると思われた．

　A 61-year-old woman presented to our institution with right lower quadrant abdominal pain from the previous day. Localized rebound tenderness was present in the right lower quadrant. Blood testing was normal except for elevated white blood cell count and CRP. Non-contrast abdominal computed tomography （CT） scan showed mild bowel wall thickening of the appendix and cecum with fat stranding. We presumptively diagnosed acute appendicitis, and proceeded to emergency exploratory laparotomy. However, upon entering the peritoneal cavity we discovered the cecum was sallow and gangrenous. We performed laparoscopic ileocecal resection. Previous case reports have shown that ischemic enteritis in the right hemi-colon often leads to necrosis. Thus, patients with a history of atherosclerotic vascular disease who present with localized peritoneal signs should have surgical exploration, which may include laparoscopy.