乳糜腹水を伴った絞扼性イレウスの1例 A CASE OF STRANGULATED ILEUS ACCOMPANIED WITH CHYLE-LIKE ASCITES

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著者

    • 亀井 奈津子 KAMEI Natsuko
    • 聖マリアンナ医科大学消化器・一般外科 Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine
    • 櫻井 丈 SAKURAI Joe
    • 聖マリアンナ医科大学消化器・一般外科 Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine
    • 片山 真史 KATAYAMA Masafumi
    • 聖マリアンナ医科大学消化器・一般外科 Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine
    • 須田 直史 SUDA Tadashi
    • 聖マリアンナ医科大学消化器・一般外科 Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine
    • 月川 賢 TSUKIKAWA Satoshi
    • 聖マリアンナ医科大学消化器・一般外科 Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine
    • 大坪 毅人 OHTSUBO Takehito
    • 聖マリアンナ医科大学消化器・一般外科 Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine

抄録

症例は64歳,男性.嘔気と次第に増強する腹痛を主訴に近医を受診し,絞扼性イレウスと診断され,当院へ搬送された.来院時,意識清明であったが,腹部全体が膨隆し左側腹部に圧痛を認めた.腹部CT検査で,肝周囲から膀胱直腸窩にかけて多量の腹水を認めた.また,上腸間膜動脈を中心に腸間膜が約180度回転しており,絞扼性イレウスと診断し,同日緊急手術を行った.開腹時,約1,000mlの乳糜様腹水を認め,上腸間膜動脈を軸に時計軸方向に約180度捻転していた.小腸はやや紫色に変色し,小腸腸間膜内に乳糜様の液体貯留を認めた.捻転解除後速やかに小腸の色調は改善し,腸間膜内の乳糜様液体貯留も改善した.術後経過は良好で第10病日に退院した.

A 64-year-old man consulted a clinic in his neighborhood because of nausea and a gradually aggravating abdominal pain. He was diagnosed strangulated ileus and was referred to our hospital. Upon arrival, his level of consciousness was normal but the whole abdomen was swollen and pressure pain was recognized in the left flank. Abdominal CT revealed a large amount of ascites from the periphery of the liver to the vesicorectal fossa. Furthermore, there was about 180 degree torsion of the mesentery with the superior mesenteric artery as the axis, which led to the diagnosis of strangulated ileus. Accordingly, an emergency operation was performed on the same day. When we opened the abdomen we found a large volume (ca. 1000mL) of chyle-like ascites, and about 180 degree torsion of the mesentery in the clockwise direction with the superior mesenteric artery as the axis. The small intestine was pale purple and chyle-like fluid retention was observed in the small intestine mesentery. After the torsion was freed, the color of small intestine rapidly improved and the retention of chyle-like fluid in the mesentery tended to decrease. The post-operative course was favorable and the patient was discharged 10 days after the onset of symptoms.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association  

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 69(7), 1683-1686, 2008-07-25 

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10021944650
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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