胃切除後に発症したileosigmoid knotの1例  [in Japanese] A CASE OF ILEOSIGMOID KNOT FOLLOWING A GASTRECTOMY  [in Japanese]

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Abstract

胃切除後に発症したileosigmoid knotの1例を経験した.症例は69歳,男性,胃癌による胃切除の既往がある(59歳時).強度な腹痛を訴え来院し,既に強度な腹膜刺激症状を伴っていた.腹部X線写真(左側臥位)にて十二指腸,大腸の鏡面像を認め,腹部CTにおいて拡張したS状結腸を認めた.腸管壊死を伴ったイレウスの術前診断で緊急手術を施行した.小腸が約1mにわたり赤色,浮腫状となっており,その小腸は,反時計まわりに軸捻転したS状結腸に包みこまれる形に絞掘されていた. S状結腸を時計まわりに回転すると絞掘は解除されS状結腸,小腸の血行は回復した. S状結腸,小腸ともに切除は行わなかった.経過は順調であり第21病日に退院した.腸管結節症の発症の1つに空腹時の大量な食物摂取があげられている.胃切除後には胃の食物貯留能が低下し一度に大量の食物が腸管に流れ易く,このことが自験例には発症の一因になった可能性が考えられた.

We experienced a case of ileosigmoid knot following a gastrectomy. A 69-year-old man was seen at the hospital because of severe abdominal pain when he was already associated with severe peritoneal signs. There was a previous history of undergoing a gast rectomy for a gastric cancer. Abdominal Xp on left side decubitus revealed air fluid level formation in the duodenum and sigmoid colon. Abdominal CT scan showed a dilated sigmoid colon. Since the abdominal pain was so severe, an emergency operation was performed with a diagnosis of ileus combined intestinal necrosis. The small intestine involving about 1m became red in color and edematous. The small intestine was strangulated by the sigmod colon like it was wrapped due to counterclockwise volvulus of the sigmoid colon. When the colon was turned clockwise, the strangulation was relieved and then the circulation to the sigmoid colon and small in testine was restored. Both the colon and intestine were not resected. The clinical course was uneventful and the patient was discharged from the hospital on 21 st hospital day. Mechanisms of onset of ileosigmoid knot in clude an ingestion of large volume of foods in an empty stomach. In gast rectomized patients, the food retension ability of the stomach decreased and a large volume of food is liable to flow in the intestine at once that might cause the disease in this case.

Journal

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

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 60(8), 2135-2138, 1999-08-25

    Japan Surgical Association

References:  7

Cited by:  4

Codes

  • NII Article ID (NAID)
    10008496259
  • 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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