反復する腸重積症に対して再発予防目的に腹腔鏡下虫垂切除・回盲部固定術を施行した3例

Three cases of recurrent intussusception prophylactically treated by laparoscopic appendectomy and ileocolopexy

◆要旨：反復する腸重積症に対して腹腔鏡下に再発予防手術を行った3例を経験した．［症例1］2歳9か月，女児．5か月時に初発，以降7回再発し，手術を施行．病的先進部を認めず腹腔鏡下虫垂切除術，回腸上行結腸固定術，盲腸腹壁固定術を施行．［症例2］5歳，女児．8か月時に初発．以降5回以上再発し，手術を施行．病的先進部を認めず，腹腔鏡下虫垂切除術，回腸上行結腸固定術を施行．［症例3］3歳1か月，男児．初回の腸重積症に対して非観血的に整復．入院中に3回再発し，腹腔鏡手術を施行．病的先進部を認めず，虫垂切除術，回腸上行結腸固定術を施行．3例とも術後再発なし．反復する腸重積症において腹腔鏡下再発予防手術は選択肢の一つとなりうる．

　We experienced three cases of recurrent intussusception prophylactically treated by laparoscopic appendectomy and ileocolopexy. Case 1 involved a girl aged 2 years 9 months. Her first episode of intussusception had occurred at the age of 5 months. She had developed seven recurrences since then; therefore, an operation was performed. She underwent laparoscopic appendectomy, ileocolopexy, and fixation of the cecum. Case 2 involved a girl aged 5 years. Her first episode of intussusception had occurred at the age of 8 months. Since then, she had experienced more than five recurrences and therefore underwent surgery. Laparoscopic appendectomy and ileocolopexy were performed. Case 3 involved a boy aged 3 years 1 month. He was diagnosed with intussusception for the first time, and upon emergency admission to the hospital, was successfully treated by nonoperative reduction. However, during his hospitalization, he developed three recurrences in 2 days and therefore underwent surgery. Laparoscopic survey showed no apparent pathological lead point, and we performed appendectomy and ileocolopexy to prevent the recurrence of intussusception. None of the three patients developed postoperative recurrence. Prophylactic laparoscopic appendectomy and ileocolopexy may be an option in the treatment of patients with recurrent intussusception.