遊離空腸片採取後に発生した腸重積症の４例

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  • Small Bowel Intussusception. Complication of Harvesting a Free Jejunal Graf.

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We present here four case of adult intussusception following harvesting of a free jejunal graft. The four patients were diagnosed as having hypopharyngeal or cervical esophageal carcinoma, and a pharyngolaryngoesophagectomy was performed. To restore the esophageal continuity, a piece of free jejunal graft was harvested from the upper portion of the jejunum in each patient. The two jejunal stumps were anastomosed in an end-to-end fashion using an Albert-Lembert stitch. The patients complained of abdominal pain, nausea and vomiting during the postoperative course. At first, they were treated as having an adhesive ileus. In spite of conservative therapy, each patient required repeated surgery. Only one patient was diagnosed as having intussusception preoperatively, the rest were diagnosed as having adhesive ileus. All of them showed intussusception at surgery, and three required resection of the morbid intestine, including the leading point that was the anastomotic site. The postoperative course was uneventful in each patient, and no recurrent intussusception has occurred. After harvesting a free jejunal graft, it is necessary to remember the possibility of this rare complication.

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