シートベルト損傷による胃破裂の1例 GASTRIC RUPTURE DUE TO SEAT BELT INJURY

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シートベルト損傷による胃破裂はまれであるが,今回純粋な内圧性と考えられ,本症の成因論的に興味深い1例を経験したので報告する.症例は40歳女性,乗用車運転中対向車と衝突し,装着していたシートベルトにより下腹部を強く圧迫された.事故後次第に腹腹刺激症状があきらかとなり,腹部CTで胃下面,脾との間に低吸収域を認めたが,胸腹部単純X線像では遊離ガス像を認めなかった.開腹所見では網嚢内に多量の食物残渣が貯留し,胃体部大轡に直角な長さ6cmの裂創を認めた.創は漿膜筋層より粘膜に及び胃壁は完全に離開していた.創縁は鋭く,他の漿膜面に損傷を認めなかったため胃切除は行わず離開部の縫合閉鎖のみ行った.本例はシートペルトによる下部腸管の圧迫の結果,機能的閉鎖腔を形成した胃において内圧が急激に上昇し,もっとも強い抗力が働いた大轡側で破裂したものと考えられた.

Gastric rupture due to seat belt injury is rare. We experienced such a case of gastric rupture which was etiologically interesting. A 40-year-old woman was admitted to the hospital following an automobile accident. She was wearing a lap and shoulder type seat belt and was compressed her lower abdomen by the belt at the collision. After admission, her abdomen gradually showed muscular defence and tender-ness. Computed tomography of the abdomen revealed a low density area around the stomach, but plain abdominal and chest radiography could not show any intraabdominal free gas. At laparotomy, omental bursa was filled with a large quantity of remnants of foods and the stomach had been lacerated across the longitudinal axis at the body near the greater curvature. Gastric wall was transected from the serosa through mucosa. There was no other injury on the serosa, so we closed the laceration and did not resect the stomach. In this case, we suppose that seat belt compressed the lower intestinal tract, and it made the functional closed loop at the stomach. Bursting was the result of a closed loop obstruction increasing intraluminal pressure.

収録刊行物

  • 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society

    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 56(9), 1834-1837, 1995-09-25

    Japan Surgical Association

参考文献:  11件中 1-11件 を表示

被引用文献:  12件中 1-12件 を表示

各種コード

  • NII論文ID(NAID)
    10008515453
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    03869776
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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