小腸腸間膜裂孔ヘルニアにより非特異的な新生児イレウスを呈した極低出生体重児の1例  [in Japanese] A Case Report of Non-Specific Neonatal Ileus Owing to Congenital Mesenteric Hernia in a Very Low Birth-Weight Infant  [in Japanese]

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Author(s)

    • 栗原 將 Kurihara Sho
    • 県立広島病院成育医療センター小児外科 Department of Pediatric Surgery, Hiroshima Prefectural Hospital
    • 赤峰 翔 Akamine Sho
    • 県立広島病院成育医療センター小児外科 Department of Pediatric Surgery, Hiroshima Prefectural Hospital

Abstract

症例は生後57日の男児,在胎29週2日1,160gで出生した.出生時より腹部膨満を認め,各種画像では部分的に著明に拡張した腸管を認め,当初は腸管部分拡張症,メコニウム病を疑い開腹したが診断には至らず,腸管拡張部を腸瘻とした.初回手術後もイレウス症状が遷延したため再度開腹したところ,術中所見で小腸腸間膜裂孔ヘルニアと確定診断を得た.小腸間膜裂孔ヘルニアは先天性の異常裂孔に起因する内ヘルニアと定義される.臨床上は絞拒性イレウスとして急激な経過を辿ることが多い.自験例ではイレウスが遷延し,非特異的な経過を辿って診断に至った.消化管穿孔に至る前の腸閉塞の段階では,内科的治療の限界を見極めることは難しく,消化管穿孔を来してから外科的治療の介入を開始することが多い.低出生体重児における消化管穿孔による死亡率は依然高く,治療抵抗性のイレウスを呈する低出生体重児の鑑別診断において,本疾患も念頭に置くことが重要と考えられた.

Intestinal mesenteric hernia is a form of internal hernia due to a congenital defect in the mesentery. It is a rare but serious cause of intestinal obstruction. We report a rare case of intestinal mesenteric hernia in a male born at 29 weeks of gestational age with a birth weight of 1,160 g. There were no apparent congenital abnormalities. At birt he had severe abdominal distention without peritoneal signs, and showed generalized intestinal distention on an abdominal X-ray. Since we suspected meconium-related ileus and segmental dilatation of the intestine at first, we performed T-tube drainage. However, as he continued to show symptoms of postoperative ileus, another laparotomy was performed, revealing congenital mesenteric hernia was located at the ileum end. Although congenital mesenteric hernia is rare, it may be fatal unless immediate surgery is performed.

Journal

  • Journal of the Japanese Society of Pediatric Surgeons

    Journal of the Japanese Society of Pediatric Surgeons 48(6), 937-943, 2012

    The Japanese Society of Pediatric Surgeons

References:  29

Codes

  • NII Article ID (NAID)
    110009544281
  • NII NACSIS-CAT ID (NCID)
    AN00192281
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    0288-609X
  • Data Source
    CJP  NII-ELS  J-STAGE 
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