论文信息 - A CASE OF PRIMARY VOLVULUS OF THE SMALL INTESTINE IN AN ADULT WITH NO PAST HISTORY OF LAPAROTOMY

A CASE OF PRIMARY VOLVULUS OF THE SMALL INTESTINE IN AN ADULT WITH NO PAST HISTORY OF LAPAROTOMY

症例は57歳, 男性. 既往歴は特にない. 突然上腹部の激痛が出現し, 当院救急外来受診. 腹膜刺激症状はなかったが, 冷汗を伴う強い疼痛であった. 腹部X線検査で軽度の小腸ガス像を認め, 腹部造影CT検査で上腸間膜動脈周囲の巻き込み像 (Whirl-like pattern) を認めたため, 小腸軸捻転症疑いにて症状出現時より8時間後に緊急手術を施行した. Treitz靱帯より肛門側に210cmの小腸が時計回りに180度回転しており, 解剖学的異常, 腫瘍, 異常索状物等なく, 原発性小腸軸捻転症と診断した. 小腸約80cmが壊死に陥っていたため, 切除後端々吻合した. 経過は良好で, 術後9日目に退院した. 本症の成人発病例は本邦では稀であり, 術前診断も困難なことが多いが, 本例においては特徴的なCT所見を認めたため, 早期診断・早期治療が可能であった.

S. Shibasaki | Atsushi Imai | Reiji Sawaya | N. Yoshikawa

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