乳糜腹水を伴った小児小腸捻転症の1例

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  • A CASE OF INTESITINAL VOLVULUS WITH CHYLOUS ASCITES IN A CHILD

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A rare case of intestinal volvulus with chylous ascites in a child is described.<br> A 13-year-old girl was admitted to the hospital because of low abdominal pain with sudden onset. There were tenderness and vebownd tendesness. CT scan revealed a lot of ascites and bowel obstruction. On emergency laparotomy, chylous ascites, intestinal volvulus rotating clockwise by 360, ischemic changes of the small intestine, and dilation of lymphducts in the mesenterium and intestinal serosa were observed. Since the small intestine was quickly recovered from the ischemic change after manual reduction of the voluvulus, intesitinal resection was not performed. In addition, cecum mobile and Meckel's diverticulum were found, which were considered the causative factor of the volvulus. Appendectomy and diverticulectomy were performed.<br> Postoperative course was uneventful, and there has been no sign of recurrence as of four years after the operation. It is thought that, though the origin of chylous ascites was obscure, the presence of cecum mobile might induce the intestinal volvulus to cause obstruction of the lymphducts, with the consequent lymphorrhea.

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