盲腸軸捻転症の3例 [in Japanese] THREE CASES OF CECAL VOLVULUS [in Japanese]
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盲腸軸捻転症は比較的稀で,診断,治療に難渋することの多い疾患である.盲腸軸捻転症を3例経験したので報告する.<br> 症例1は77歳,男性.慢性呼吸不全で寝たきりの状態であった.腹痛,腹部膨満のため入院,腹膜炎の診断の下に開腹,盲腸が180度捻転して壊死していたため,回盲部切除術を行った.術後呼吸管理に難渋したが術後50日で退院となった.<br> 症例2は69歳,男性.腹痛のため入院.腹部単純X線写真,腹部CT,注腸像より本症と診断し,開腹した.回盲部が180度捻転し,頭側に反転していた.血行障害を認めなかったので整復,盲腸を固定した.<br> 症例3は63歳,女性.腹痛のため入院,精査を行ったが,確定診断に到らず入院後約2週間後に手術を行った.盲腸,上行結腸が広範に壊死していた.小腸を含めて右半結腸切除術を行った.術後経過は良好であった.
Cecal volvulus is a relative rare disease and it is difficult to diagnose it before laparotomy.<br> Case 1. The patient was a 77-year-old man with chronic respiratory failure who was confined to bed. He was admitted to our hospital because of abdominal pain and fullness. He was diagnosed as having peritonitis of unknown origin. During surgery, the cecum was rotated 180 degrees clockwise and was found to be necrotic. An ileocecal resection was carried out. The postoperative course was uneventful.<br> Case 2. A 69-year-old man was admitted to our hospital with abdominal pain. Plain abdominal X-ray, abdominal CT and a Gastrographin enema findings suggested cecal volvulus, and an emergency operation was carried out. During surgery, the cecum was rotated 180 degrees clockwise but it was not found to be necrotic. Since the patient had a long mobile cecum, cecopexy between the cecum and the parietal peritoneum was carried out following detorsion of the voluvulus. The postoperative course was uneventful.<br> Case 3. A 63-year-old woman was admitted to our hospital with abdominal pain. Definite diagnosis was not established for 2 weeks, when the urinary tract was examined folowing a UGI series via an ileus tube, and emergency operation was carried out. The cecum and ascending colon were necrotic. A right hemicolectomy was carried out. The postoperative course was uneventful.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 58(10), 2375-2380, 1997-10-25
Japan Surgical Association