腸切除せずに治癒しえた成人原発性小腸軸捻転症の1例  [in Japanese] A CASE OF TORSION OF SMALL INTESTINE IN AN ADULT SUCCESSFULLY TREATED WITHOUT BOWEL RESECTION  [in Japanese]

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Abstract

小腸軸捻転症は稀な疾患で,術前診断されることは少なく,発症後は急速に広範な小腸壊死を生じ致死的な経過をとることが多い.今回われわれは,特徴的なCT像より術前診断し,腸切除せずに治癒しえた成人原発性小腸軸捻転症の1例を経験したので報告する.症例は74歳,男性.朝食後より上腹部痛が出現し近医受診.腹部X線写真にてイレウスと診断され当科受診.腹部CTにて上腸間膜動脈を中心とした小腸の渦巻き状巻き込み像を認め,小腸軸捻転症と診断した.入院後,腹痛の増強や炎症反応の上昇を認めず,保存的に経過観察していたが,入院4日目に血清CPK値の上昇を認め手術施行した.小腸全体が反時計回りに180度捻転するも,腸管壊死等の血流障害の所見を認めず,整復のみでイレウスを解除した.またTreitz靱帯から45cmと100cmの2カ所の部位に空腸憩室を認めた.患者は術後30日目に退院した.

Torsion of small intestine is a rare entity and few patients are diagnosed preoperatively. Once it occurs, rapid and extensive necrosis over the small intestine develops and the patient follows a fafel course. This time, we successfully managed an adult patient with torsion of small intestine without bowel resection, by making the early diagnosis based on characteristic CT findings.<br> A 74-year-old man, who had upper abdominal pain after a breakfast and was diagnosed as having ileus based on an abdonimal plain x-ray film at another hospital, was seen at the hospital. Abdominal CT scan revealed a screwshaped small intestine involving the superior mesenteric artery as the center. Torsion of the small intestine was diagnosed. After admisiion, no aggravation of the abdominal pain nor increase in inflammatory response was noted and the patient was observed conservatively. On the 4th hospital day, however, an increase in CPK level was confirmed and the patient was operated on. At surgery, the entire small intestine was twisted counterclockwise by 180 degree, but no circulatory impairments such as intestinal necrosis were demonstrated. The intestinal obstruction was freed only by reducing the twisted intestine. And there appeared two jejunal diverticula at 45cm and 100cm from the Treitz' ligament. The patient was discharged from the hospital 30 days after the operation.

Journal

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

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 63(1), 117-121, 2002-01-25

    Japan Surgical Association

References:  16

Cited by:  11

Codes

  • NII Article ID (NAID)
    10008392911
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13452843
  • Data Source
    CJP  CJPref  J-STAGE 
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