開腹歴のない若年者絞扼性イレウスの1例

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  • STRANGULATED ILEUS IN A JUVENILE PATIENT WITHOUT HISTORY OF LAPAROTOMY

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A 13-year-old boy was referred to the hospital because of upper abdominal pain and vomiting on January 27. 1998. When he was first seen, fever, sustained upper abdominal pain with mild muscle gurding, hyperleukocytosis, and an increase in CRP were noted. Abdominal x-ray film and CT scan revealed a dilatation of the small intestine and ascites. With a suspicion of strangulated ileus, an emergency operation was performed. Under general anesthesia, a laparoscopy was inserted, when the discolored intestine to dark violet and bloody ascites were confirmed, and hence it was shifted to laparotomy. During operation, the jejunum ranging 40cm started at about 10cm anal from the Treitz's ligament was necrosed, and strangulated ileus due to adhesion between the small bowel mesentery and cord was confirmed. The strangulation was relieved and a resection of the necrosed intestine was performed, followed by end-to-end anastomosis of the jejunum. On the 20th hospital day the patient was discharged from the hospital.<br> Strangulated ileus due to mesenteric adhesion of unknown origin which involves a juvenile patient without previous history of undergoing laparotomy like this case is thought very rare. This paper reports the rare case with some bibliographical comments in terms of the diagnosis and treatment.

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