絞扼性イレウスを発症したS状結腸間膜内ヘルニアの1例 A CASE OF STRANGULATED ILEUS DUE TO INTRAMESOSIGMOID HERNIA

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症例は80歳男性.腹痛,嘔吐を主訴に来院した.受診時,腹部全体に圧痛を認めたが,腹膜刺激症状はなかった. 腹部X線. CTにてニボー. 腹水を認め. イレウスの診断で入院となり,イレウス管留置による保存的治療を行うも症状の改善を認めず,発症後4日目に手術を施行した.開腹するとS状結腸間膜右葉に10cmの異常裂孔を開口部とするヘルニア嚢を認めた.そのヘルニア内容物はTreitz靱帯より10cmの部位より160cmの小腸であり,それにつづく紅門側の小脇が捻転し壌死に陥っていた.壊死腸管は70cmであり壊死腸管を含む126cmの小腸切除と裂孔部の閉鎖を行い手術を終了した. 術後22日目に退院となった.<BR>S状結腸間膜内ヘルニアは本例が本邦において13例目であった.腹部外傷や開腹手術の既往歴がなくイレウスで発症した症例では内ヘルニアによる絞扼牲イレウスを念頭におき,早期診断と治療を考慮すべきである.

An 80-year-old man was admitted to the hospital because of abdominal pain and vomiting. He had neither a past history of undergoing surgery nor injury. An abdominal X-ray film and a CT scan showed niveau and ascites. A conservative therapy with an ileus-tube was made, but no symptomatic remission could be achieved. At laparotomy on the 4th day after the onset of symptoms, we found a 400 ml dark red fluid collection and a necrotic small intestine. There was a mesenteric defect 10.0×10.0 cm in size on the right side of the sigmoid colon which included the 160cm small intestine 10cm distal from the Treitz ligament. The necrotic small intestine followed the small intestine in the mesenteric defect of the sigmoid colon and it was about 70 cm in length. The mesenteric defect of the sigmoid colon was so huge that the small intestine in it had no circulation obstacle. The strangulated ileus might occur because the mesojejunum in the mesenteric defect was so tensioned. We successfully treated this case with a resection of the necrotic small intestine and with closure of the hernia opening orifice. The patient was discharged from the hospital 22 days after the operation.<BR>In Japan 13 cases of intramesosigmoid hernia have been reported including this case. Intestinal obstruction in a patient without history of undergoing surgery should be suspected of a possible internal hernia and we should not miss the opportunity for an operation.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 62(3), 817-820, 2001-03-25

    日本臨床外科学会

参考文献:  11件中 1-11件 を表示

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各種コード

  • NII論文ID(NAID)
    10008389194
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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