日本新生児成育医学会雑誌　第32巻　第1号　172 ～ 176頁（2020年）

日本新生児成育医学会雑誌　32(1)：172-176；2020　

受付日：2019．03．19

受理日：2019．10．18

出生前診断され，早期新生児期に腸軸捻転を発症した腸間膜嚢腫の1 例

Intestinal Volvulus during Early Neonatal Period caused by Congenital Mesenteric Cysts Diagnosed in Utero：A Case Report

＊1 大阪大学大学院医学系研究科　小児科学，＊2 大阪大学大学院医学系研究科　外科学講座　小児成育外科学，＊3 現所属：鹿児島市立病院　新生児内科，＊4 現所属：社会福祉法人石井記念愛染園附属愛染橋病院　小児科，＊5 現所属：地方独立行政法人大阪府立病院機構大阪母子医療センター　新生児科

＊1 Department of Pediatrics, Osaka University Graduate School of Medicine，＊2 Department of Pediatric Surgery, Osaka University Graduate School of Medicine，＊3 Department of Neonatal Medicine, Kagoshima City Hospital，＊4 Department of Pediatrics, Aizenbashi Hospital，＊5 Department of Neonatal Medicine, Osaka Women’s and Children’s Hospital

神原正宜＊1＊3・谷口英俊＊1・辻田麻友子＊1・甲斐明彦＊1＊4・荒堀仁美＊1・北畠康司＊1・和田和子＊1＊5・田附裕子＊2・大薗恵一＊1

Masanori KAMBARA＊1＊3，Hidetoshi TANIGUCHI＊1，Mayuko TSUJITA＊1，Akihiko KAI＊1＊4，Hitomi ARAHORI＊1， Yasuji KITABATAKE＊1，Kazuko WADA＊1＊5，Yuko TAZUKE＊2，Keiichi OZONO＊1

Key Words：prenatal diagnosis，mesenteric cyst，ileus，intestinal torsion

出生前診断された腸間膜嚢腫に対する手術時期について明確な指針は現時点では存在しない。症例は胎児期より腹腔内嚢腫が指摘されていた日齢0 の女児。出生後の腹部超音波検査では多房性嚢腫を認めたが，いずれも径は小さく無症状のため，待機手術予定とし経過観察していた。生後6 時間，胆汁性嘔吐が出現し，腸間膜嚢腫による腸軸捻転と診断し，緊急切除術を施行。腸管壊死のため約5cm の腸切除を要した。術後経過は良好で生後3 週間で軽快退院となった。出生前診断された腸間膜嚢腫では出生後早期の腸閉塞のリスクが問題となる。今回の経験から多房性嚢腫の場合には個々の嚢腫の大きさよりも，嚢腫全体の最大径によって腸閉塞のリスクを認識し，出生後早期の切除を考慮する必要があると示唆された。

In cases of mesenteric cysts, surgical excision is recommended as soon as the diagnosis has been made. However, there is no specific guideline to determine the optimal timing of the surgery for congenital mesenteric cysts. A post-natal day-zero female infant was admitted to our neonatal intensive care unit（ NICU） because of ileus at six hours after birth. Her intraperitoneal cysts were detected prenatally, and the diagnosis of mesenteric cysts was made immediately after birth. Each cyst was smaller than 3 cm and was considered small enough for elective surgery. However, she developed bilious vomiting and ileus was suspected. Immediately after admission to NICU, intestinal torsion caused by mesenteric cysts was identified, and surgical excisions of the cysts were performed. An intestinal resection of approximately 5 cm had to be made because of tissue necrosis. There was no other complication, and she was discharged home at three weeks old. Congenital mesenteric cysts may cause ileus during the early neonatal period. This case suggests that the maximum diameter of the whole group of cysts rather than the size of each cyst is important to assess the risk of ileus, and early excision of the cysts may be recommended in these cases.