双胎妊娠27週妊婦の急性虫垂炎に対して腹腔鏡下虫垂切除術を施行した1例

A case of laparoscopic appendectomy for acute appendicitis during the second trimester of a twin pregnancy

◆要旨：21歳，女性．双胎妊娠27週であった．腹痛を主訴に当院を受診した．発熱および下腹部痛，炎症反応の上昇を認めた．急性虫垂炎を疑い産科医師と相談の上，腹部CT検査により急性虫垂炎と診断し，腹腔鏡下虫垂切除術を施行した．トロッカー挿入部位の工夫などにより良好な視野を得て，安全に手術を施行できた．最終的に母児共に問題なく出産することができた．妊婦の急性虫垂炎は重症化しやすく，腹膜炎を発症すると死産や流産のリスクが高くなることが知られている．近年，妊婦に対する腹腔鏡下虫垂切除術の報告は散見されるようになってきたが，双胎妊娠の妊婦に腹腔鏡下虫垂切除術を施行した稀な症例を経験したため，文献的考察を加えて報告する．

　There are still only few cases in which laparoscopic appendectomy is performed in pregnant patients with acute appendicitis in our country. For pregnant patients, laparoscopic appendectomy is a good option for safely undergoing surgery. We herein report a rare case of laparoscopic appendectomy performed for a patient with acute appendicitis who had a twin pregnancy. A 21year-old-woman who was pregnant with twins presented with abdominal pain and was diagnosed with acute appendicitis. We performed the surgery safely with proper port placement and low pneumoperitoneal pressure. Her early postoperative course was good, with relatively little pain and no complications, and she was discharged on day 5. After the surgery, because of her twin pregnancy, the patient was scheduled to receive Caesarean section and delivered two healthy babies. Surgery for pregnant patients must be safe with little invasion. The present case suggests that, with proper port placement and low pneumoperitoneal pressure, laparoscopic appendectomy is a good option for pregnant patients with acute appendicitis in light of its low invasiveness.