Mesodiverticular bandによる絞扼性イレウスの一例

症例は14歳,男児.開腹歴を含め,既往歴に特記すべきものなし.下痢,腹痛を主訴に来院し,抗生剤投与で一時軽快したが,その後腹部膨満感出現し,緊急入院となった.入院時血液検査所見で炎症反応の異常高値とCT検査上絞拒性イレウスの所見を認めたため緊急開腹手術を施行した.術中所見は回腸から約60cm口側にメッケル憩室を認め,そこに付着したmesodiverticular bandにより回腸が内ヘルニアを形成していた.小腸は広範囲に壊死しており,小腸部分切除を行った.mesodiverticular bandによるイレウスは稀で,術前診断は困難であるため手術歴のないイレウスの原因として考慮すべきであると考えられた.The patient was a 14-year-old boy who was admitted to our hospital because of abdominal pain and diarrhea. Blood tests showed strong inflammation, and plain CT showed the presence of air and fluid in the ileum. In physical findings, pan-peritonitis was suspected with muscle guarding, and so on emergency operation was performed. During the operation, we found that the ileum was compressed by a herniation of the mesodiverticular band and Meckel\u27s diverticulum. The a long segment of the ileum was necrotic, so these portions were resected and an end to side anastomosis was made. In a pathological study, neither gastric mucosa nor pancreatic tissue were observed, but microvessels were seen. Diagnosis is difficult before operation, so we should consider the mesodiverticular band when we see young ileus cases