虚血性回腸炎穿孔の1例  [in Japanese] A CASE OF PERFORATION OF ISCHEMIC ILEITIS  [in Japanese]

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Abstract

胃癌の再発による横行結腸の狭窄のため虚血性回腸炎に陥り,穿孔をきたした症例を経験したので報告する.<BR>症例は71歳の男性.1997年10月,胃癌の診断にて胃全摘術,胆摘,脾摘,膵体尾部合併切除術,横行結腸間膜部分切除術を施行.同12月末頃より軽度の腹痛が出現したため再入院.翌1997年1月14日に急激に腹痛が増悪し,汎発性腹膜炎と診断,開腹した.回腸にびまん性の中等度の拡張と浮腫を認め,回腸末端より約30cmの回腸の腸間膜付着部対側に4mm径の穿孔を認めた.横行結腸は胃癌の再発による癒着で狭窄をきたしていた.手術は小腸部分切除術,回腸に人工肛門造設術を行った.摘出した回腸の病理組織学的所見より,虚血性回腸炎の穿孔と診断した.胃癌の再発による横行結腸の狭窄が原因で小腸が拡張し,血行障害をきたして多発性の潰瘍を生じ,その1つが穿孔したと考えられた.

A case of perforation of ischemic ileitis caused by stenosis of the transverse colon due to recurrence of gastric cancer is reported here. A 71-year-old man was admitted to the hospital because of mild abdominal pain at the end of December in 1997. About 2 months before admission, the patient had undergone a total gastrectomy, a cholecystectomy, a splenectomy, an associated resection of pancreatic body and tail, and a partial resection of mesentery of the transverse colon for gastric cancer in the hospital. On January 14,1998. the abdominal pain suddenly aggravated, and a laparotomy was performed with a diagnosis of generalized peritonitis. There were diffuse and moderate dilatation and edema of the ileum and a perforation 4 mm in diameter on the ileum at the reverse side to that where the mesentery adheres, and about 30 cm distal from the terminal ileum. The transverse colon revealed a narrowing caused by adhesion due to recurrence of the gastric cancer. A partial resection of the small intestine was performed and an artificial anus was made at the ileum. Bases on histopathological findings of the resected ileum. perforation of ischemic ileitis was diagnosed.<BR>It is thought that the narrowing of the transverse colon due to recurrent gastric cancer caused the dilatation and resultant ischemia of the small intestine to lead to multiple ulcers. And one of them might perforate.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 62(2), 406-409, 2001-02-25

    Japan Surgical Association

References:  11

Codes

  • NII Article ID (NAID)
    10008388146
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    13452843
  • Data Source
    CJP  J-STAGE 
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