内視鏡的切除後,遅発性胃穿孔をきたした胃粘膜下腫瘍の1例  [in Japanese] A CASE OF DELAYED PERFORATION OF THE STOMACH AFTER ENDOSCOPIC RESECTION OF SUBMUCOSAL TUMOR  [in Japanese]

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Abstract

49歳男性.検診で胃の病変を指摘されたため,精査加療目的で当院を受診された.上部消化管内視鏡検査によってcardia近傍に直径1cmの粘膜下腫瘍を確認した.生検鉗子による操作では,腫瘍の粘膜内での可動性が高く,腫瘍と固有筋層との関連性はないと思われた. 2週間後に粘膜下腫瘍の内視鏡的切除を試みた.腫瘍切除術後,切除面に固有筋層が観察されたが,出血および穿孔はみられなかった.また術後病理組織検査では,腫瘍は被膜に包まれて切除されており,固有筋層成分はみられず,内視鏡的切除による固有筋層の損傷は軽度と思われた.しかし内視鏡治療後約7時間経過してから胃穿孔が生じ再来院した.内視鏡的切除術に伴い固有筋層の損傷が軽度であり,術直後穿孔がみられなくても,術後経過してから穿孔する可能性を決して否定できないため,切除後の粘膜欠損部を閉鎖することが重要と思われた.

A 49-year-old man was seen at the hospital because he was pointed out having a gastric lesion at a physical examination. A submucosal tumor 1cm in diameter located paracardia was observed with endoscopy. There was no connection between the tumor and the proper muscle layer because the tumor had high mobility within the submucosal layer. We tried an endosopic resection for the gastric lesion 2 weeks later. After the tumor resection, the proper muscle layer was clearly observed in the resected surface, and no bleeding nor perforation was seen. And a pathological study documented us that the tumor was removed with wrapped capsule and without any proper muscle layer component. So we thought that the proper muscule layer had been slightly damaged by the endoscopic procedure. However, he was seen at the hospital again because of perforation of the stomach about 7 hours passed after the endoscope procedure. It is not able to rule out the possibility of delayed perforation of the stomach after the endoscopic procedure, nevertheless the damage of the proper muscle layer would be slight and no immediate perforation would be observed. It is very important to close a mucosal defect by endoscopic procedure with crips or any other goods.

Journal

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

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 60(9), 2353-2356, 1999-09-25

    Japan Surgical Association

References:  7

Codes

  • NII Article ID (NAID)
    10008496787
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    13452843
  • Data Source
    CJP  J-STAGE 
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