小児鈍的外傷性十二指腸穿孔に対する早期診断と治療指針  [in Japanese] Initial Diagnosis and Surgical Strategy for Blunt Traumatic Duodenal Perforation in Childhood  [in Japanese]

症例1は,8歳の男児,症例2は,4歳の女児で,ともに鈍的外傷性十二指腸穿孔を認めた症例である.外傷性十二指腸穿孔は,解剖学的な構造から,他の腹部外傷による臓器損傷に比べて発症数は少ない.また,画像診断の困難性から,手術適応の時期決定と適切な治療手段の選択に難渋することがある.万一,治療選択の適正を誤れば,重度の合併症を併発させることになり,手術中における冷静な判断能力が問われる症例でもある.術前に施行した画像検査をもとに,穿孔部位を十分に把握した上での治療が肝要である.さらに,救急疾患では,緊急対応を要求されることも多々あり,患児の遺伝的疾患による合併症の有無が生死の分岐点になることもある.入院時には,患児の重篤度により,緊急処置を優先させることも多いが,家族からの詳細な情報聴取が,患児の全身管理の上でも重要であると考えられる.

We report two cases of blunt traumatic duodenal perforation which could not be seen the perforated portion easily by the preoperative radiographic assessment. The first case was an 8-year-old boy and the second was a 4-year-old girl. A traumatic duodenal perforation is much rarer than any other visceral injury by means of abdominal trauma on the basis of anatomical structure. It is sometimes difficult to decide an optical timing for surgical repair and to choose feasible surgical treatment on account of the difficulty of radiographic assessment. Moreover, some severe complications may be induced if a judgment of selection in any surgical treatment is mistaken. Generally, it is necessary in these cases to make some appropriate judgments during the operation. It is important to perform surgical repair for the perforated portion on the basis of preoperative radiographic examination. Furthermore, many times emergency treatment is required in an urgent disease regardless of whether a patient has a hereditary disease or not. Thus, it is important to get information in detail from his family at admission. A prudent management is important as an emergency surgical repair has some dangerous elements, for example, unexpected bleeding, leakage at anastomosis, postoperative ileus and so on.