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From Local Schools to a Global Conference : Sharing Lesson Study Implementation in African Countries at the World Association of Lesson Study Conference 2023
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A Case of Idiopathic Omental Torsion Diagnosed Preoperatively and Treated by Laparoscopic resection.
Get PDF症例は63 歳，男性であり，2 週間持続する右側腹部痛を主訴に(独)地域医療機能推進機構（JCHO）福井勝山総合病院を受診した。身体所見では右中腹部に筋性防御を伴う圧痛を認め，血液検査所見では C-reactive protein (CRP)が軽度上昇している以外には特記異常所見を認めなかった。腹部造影CT 検査では大網の右側横行結腸への付着部付近に脂肪織濃度の上昇があり，周囲に捻転した血管と思われる索状影が延びていた。
CT 検査所見より大網捻転症と診断し，緊急で腹腔鏡下大網切除術を施行した。術中所見では右上腹部に少量の血性腹水と暗赤色に色調変化した大網を認めた。大網は右側横行結腸への付着部で捻転しており，捻転の基部を超音波凝固切開装置で切離し摘出した。本症は急性腹症を来す比較的まれな疾患であるが、特徴的なCT 像をとらえることができれば術前診断が可能であり、腹腔鏡下手術による低侵襲手術が可能であると考える。
The case patient was a 63-year-old male. The patient was admitted with right abdominal pain that lasted for 2 weeks.
Physical findings showed tenderness with muscular defense in the right middle abdomen, and blood test findings showed a slight increase in C-reactive protein (CRP). Contrast-enhanced computed tomography (CT) of the abdomen showed increased density of fatty tissue near the attachment of the omentum majus to the right transverse colon, associating with cord-like shadow extending around it that appeared to be twisted blood vessels. Based on the CT findings, omental torsion was diagnosed preoperatively, and emergency laparoscopic surgery was performed.
Intraoperative findings revealed a small number of bloody ascites and omentum majus discolored dark red-colored in the upper right abdomen. The omentum majus was twisted at the attachment to the transverse colon. The twisted omentum majus was resected at the attachment with an ultrasonic coagulation incision device. Idiopathic torsion of the omental majus is a relatively rare disease that causes acute abdomen, preoperative diagnosis is possible if a characteristic CT image can be captured, and minimally invasive surgery by laparoscopic surgery is possible.departmental bulletin pape