S状結腸過長症術後に発症した精神発達遅滞者における下行結腸軸捻転の1例

A 49-year-old woman who had an intellectual disability was examined during an emergency visit at our hospital because of abdominal swelling. Her abdomen was remarkably distended but without tenderness. Abdominal plain radiography revealed an enlarged colon in the upper abdomen. As abdominal contrast-enhanced computed tomography （CT） revealed volvulus of the descending colon, she underwent emergency surgery. The descending colon was mostly not fixed at the retroperitoneum and was rotated 180° counter-clockwise. The thin and ischemic parts of the colon were resected, and Hartmannʼs operation was performed. She underwent reconstruction surgery 2 months later. Volvulus of the colon with megacolon carries a high risk and requires emergency surgery. In patients with intellectual disabilities, notification of symptoms and diagnosis of volvulus are usually delayed because of the patientsʼ difficulty in communication. Clinical history taking, careful examination of the patient and taking a CT scan in the early stage are highly important. The appropriate surgical procedures must also be decided in consideration of the risk of complications and reduced quality of life.