腹腔鏡診断が有用であった高齢者に発症した腸結石を伴う小腸憩室炎の1例

An ８２-year-old man visited his primary care doctor for epigastralgia and lower abdominal fullness. The next day, he was referred to our hospital on suspicion of ileus. Abdominal CT scan revealed dilated intestinal loops and a well-circumscribed mass lesion within the small bowel. We performed an emergency operation based on the diagnosis of secondary enterolith ileus. Laparoscopy demonstrated numerous large diverticula on the dilated jejunum. We removed the inflammatory intestinal mass from the abdominal cavity and partially resected the small intestine. Pathology indicated diverticulitis with enterolith. Jejunal diverticulitis is rare and difficult to diagnose preoperatively. The laparoscopic procedure was useful to detect the location of the inflammatory mass and multiple diverticula. Furthermore, laparoscopy is useful for checking the peritoneal cavity for irregular communication between the gallbladder and the gastrointestinal tract to exclude gallstone ileus in cases of enterolith causing bowel obstruction. Jejunal diverticular disease should be considered in the differential diagnosis of mechanical bowel obstruction, especially in the elderly population.