画像診断しえた若年女性の遊走脾捻転に対して腹腔鏡下脾固定術を施行した1例

A case of laparoscopic splenopexy for migrating splenic torsion in a young woman

◆要旨：遊走脾は稀な疾患である．術前の画像検査で脾捻転を診断し，緊急で腹腔鏡下脾固定術を施行しえた症例を経験したので報告する．症例は32歳，女性．急性発症の上腹部痛と嘔吐を主訴に当院を受診した．腹部造影CT，MRIでは，脾臓の一部造影不良と，脾門部にwhirl signを認めた．遊走脾に伴う脾捻転と診断し，緊急手術を施行した．腹腔内は，脾臓が反時計回りに540度回転していた．捻転を解除すると色調は改善し，腹腔鏡下に脾臓を固定し温存した．術後の経過は順調で術後3日目に退院した．術後1年再発なく経過している．

　Migrating spleen is a rare disease. We report a case of splenic torsion diagnosed by preoperative imaging and treated by laparoscopic splenopexy. A 32-year-old woman was presented to our hospital with a chief complaint of acute onset abdominal pain. Abdominal contrast-enhanced CT and MRI showed poor contrast in part of the spleen and a whirl sign at the splenic hilum. The diagnosis of splenic torsion associated with migrating spleen was made, and emergency surgery was performed. The spleen was rotated counterclockwise by 540 degrees. When the torsion was released, blood flow of the spleen recovered. The spleen was immobilized laparoscopically and preserved. Postoperative course was good, and the patient was discharged on the third postoperative day. One year has passed and she has been enjoying her healthy life without any symptom.