高齢者に発症した術後腸重積症の１例

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  • A CASE OF POSTOPERATIVE JEJUNAL INTUSSUSCEPTION IN AN OLD PATIENT

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An 88-year-old woman with a previous history of undergoing an appendectomy and a right ovariectomy for perforative peritonitis of the appendix in her twenties had had several episodes of intestinal obstruction since January 2000which had been conservatively treated. On December 20, 2001, she complained of abdominal pain and was admitted to the hospital with a diagnosis of intestinal obstruction. Conservative therapy by inserting an ileus tube was started, but after repeated aggravation and remission of the symptoms, delayed inflammatory findings and a progress of malnutrition were confirmed so that surgery was performed on March 19, 2002. Upon laparotomy, we saw an intussusception in the jejunum covering about 20cm in length about 15cm distal to the Treitz' ligament, and performed a partial jejunectomy. The patient was discharged from the hospital on the 49th postperative day. It was etiologically thought that the intussusception might be caused by operations of the tube and irritation due to the indwelt tube because the excised material revealed no organic lesions such as a tumor and diverticulum. We must think over not to be able to make the diagnosis of intussusception based on abdominal CT images; to maintain conservative therapy for intestinal obstruction; to prolong the ailing time; and to cause aggravation of the patient's general condition. In the case of frequent handling of an ileus tube, careful management is necessary by keeping a possibility of inducing some troubles in mind.

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