交通事故による消化管穿孔例の検討 CLINICAL STUDY ON GASTROINTESTINAL PERFORATION DUE TO TRAFFIC TRAUMA

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1986年11月から1994年10月までに当科において経験した交通外傷による消化管穿孔例13例を対象に,診断,治療および成因について検討を加えた.受傷者13例中8例が自動車事故での受傷で,うち5例がシートベルト着用例であった.初診時の腹部所見で筋性防御を認めた者は13例中9例(69.2%)で,残る4例も時間とともに全例で出現した.腹腔内遊離ガス像を認めた者は2例にすぎなかった.術式は小腸部分切除8例,単純縫合閉鎖4例,広範囲胃切除1例であった.穿孔部位は小腸10例,十二指腸2例,胃1例であった.穿孔部位の80%がトライツ靱帯から120cm以内に集中していることからトライツ靱帯を起始部とする閉鎖係蹄腸管内圧の上昇が穿孔の一因と考えられた.外傷性消化管穿孔は早期診断,早期治療が行われれば予後は良好である.受傷機転を考慮し,医師の観察下におき開腹の時期を逸しないよう注意しなくてはならない.

Thirteen cases of gastrointestinal perforation due to a traffic trauma seen between November 1986 and October 1994 were reviewed for keys to diagnosis and treatment. Motor vehicle accident were involved in eight (62%) out of the 13 cases and seat-belts were in use in five cases (62%). The most common location of perforations was the small intestine (10 cases), followed by the duodenum ) (2 cases) and stomach (1 cases). Muscular defense was present in nine (69%) of 13 patients at the first medical examination, and in the remaining four cases it appeared 1 to 6 hours later. Free air was noted in only two (15%) patients, that appeared 6 hours after the accident. Partial resection of the small intestine was performed in eight cases, primary closure in four cases and extended gastrectomy in one case. A rise in pressure of the closed loop of the intestine which started from the Treitz ligament was thought as the origin of the perforation, because 80% of all intestinal perforations were located within 120cm from the Treitz ligament. If an early definitive diagnosis is made and an early treatment is performed, the prognosis of the traumatic intestinal perforation should be favorable. We have to keep the patient under the strict observation and not to let the timing of the operation go by.

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 58(8), 1728-1732, 1997-08-25

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10008529268
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    03869776
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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