解離性大動脈瘤に伴う腸管虚血の診断に腹腔鏡検査が有用であった1例

A Case of Acute Aortic Dissection with Ischemic Enteritis Diagnosed by Laparoscopy

　解離大動脈瘤に伴う腸管虚血に対して腹腔鏡検査を施行し，懐死性腸管切除により救命し得た1例を経験したので報告する．症例は59歳，男性，突然の胸背部痛で発症したDeBakey Ⅲb型の解離性大動脈瘤の治療経過中に腹痛を主訴として紹介された．来院後，臨床症状は軽微であったが，腸管虚血を否定できず診断目的で腹腔鏡検査を施行した．腹腔内の観察で回盲部腸管の虚血壊死と診断し，開腹ののちに右半結腸切除，双口式人工肛門造設術を施行した．なお，術後に急性循環不全などを合併したが改善し，現在健在である，解離性大動脈瘤に伴う腸管虚血の診断法として腹腔鏡検査は簡便であり，適宜，開腹術に移行できることを考えると，病状が悪化する前に積極的に施行すべきと思われた．

We report a 59-year-old man who presented with abdominal fullness and pain. He had been diagnosed with a type III b acute aortic dissection and had been operated on for obstruction of the right femoral artery at an-other hospital. His stay at our hospital was clinically uneventful at first; physical examination and laboratory data were negative for necrotic enteritis. However, his abdominal fullness gradually grew remarkable, so ischenic enteritis was suspected and laparoscopic examination was performed. Necrotic lesion in the ileum end was observed through laparoscopy, and we converted to open surgery.