左半結腸切除術後に発症した上腸間膜動脈症候群の1例 [in Japanese] SUPERIOR MESENTERIC ARTERY (SMA) SYNDROME AFTER LEET HEMICOLECTOMY : A CASE REPORT [in Japanese]
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症例は74歳,男性.便秘を主訴に来院し,下行結腸癌の診断にて左半結腸切除術を施行した.術後9日目より食事を開始したが摂食1～2時間後に嘔吐を繰り返した.腹部CTで上腸間膜動脈(SMA)と大動脈による十二指腸水平部の圧迫,胃および十二指腸の拡張,また上部消化管造影で十二指腸水平部の垂直線状閉塞とその数時間後においても胃および十二指腸の拡張像を認めたため,左半結腸切除後のSMA症候群と診断した.約2週間保存的療法を施行したが軽快せず手術を施行した. SMAを含む腸問膜根部による十二指腸水平部の閉塞を認め,胃空腸吻合術を施行した. SMA症候群はSMAと十二指腸水平部の解剖学的位置関係の変化が発症機序の1つとされ,本症例では腸管吻合により腸間膜根部が尾側へ牽引されたと思われる.保存的療法無効例には手術が選択されるが,術式としては十二指腸空腸吻合術,十二指腸転位術,トライツ靱帯切除術なども報告されている.
A 74-year-old man came to our hospital complaining of constipation. He was diagnosed with descending colon cancer and underwent a left hemicolectomy. He started taking meals on the 9th day after operation, but had repeated vomiting one or two hours after meals. Abdominal computed tomography revealed that the third portion of duodenum was compressed between the SMA and abdominal aorta, and that the stomach and duodenum were dilated. Gastroduodenography showed a straight line cut-off of the third portion of the duodenum, and stomach and duodenum dilatation after that. He was diagnosed as having SMA syndrome after left hemicolectomy. Conservative therapy for about two weeks was not effective, and he underwent surgical reoperation. The root of the mesenterium including the SMA had occluded the third portion of the duodenum, and a gastrojejunostomy was performed. The change of anatomical characteristics between the SMA and duodenum is considered one of the causes of SMA syndrome. In this case, the root of mesenterium was thought to be retracted inferiorily by the colonic anastomosis. The postoperative course was uneventful. Anterior transposition of the duodenum, duodenojejunostomy, and Treitz's ligament resection are known as other surgical procedures for treatment of this disease.
- Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 61(1), 181-185, 2000-01-25
Japan Surgical Association