食物による閉塞により腸捻転をきたした1例

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  • A CASE OF VOLVULUS BY FOODS

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A 29-year-old male was admitted to the hospital because of an abdominal pain, nausea and vomiting. There was a previous history of undergoing a distal gastrectomy for gastric ulcer ten years prior. On the day before admission he ate two balls of Shirataki Konnyaku in Japanese Oden for dinner. A diagnosis of ileus by strangulation was made after abdominal examination, radiographic evaluation and CT scan. A laparotomy was performed and an obstruction of the ileum, 60cm from the Bauhin Valve was revealed. The impediment was a mass of Konnyaku. The oral portion of the ileum was significantly dilated and twisted. Most cases of intestinal obstruction with foods have a slow and mild onset of symptoms and undergo laparotomy with a diagnosis of adhesional ileus. But we should also entertain that the disease can present with strangulation ileus with a rapid and severe onset of symptoms as this case suggested. The use of CT scan is extremely valuable in the differential diagnosis. In order to avoid ileus with foods after gastrectomy, we emphasize the importance of selecting reconstruction method for gastrectomy after much thought and of giving the exhausive dietary education to postgastrectomy patients. And it goes without saying that we should recognize the different symptoms by ileus types.

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