小腸閉塞を来した重複毛髪胃石を内視鏡併用で臍部創より摘出した1例 [in Japanese] A Case of Pediatric Trichobezoar That Caused Intestinal Obstruction and was Removed by Laparoscope-and-Endoscope-Assisted Surgery [in Japanese]
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毛髪胃石は，経口摂取された毛髪が胃で一塊となり残存したもので落下により腸閉塞を引き起こすことがある．今回，毛髪胃石による腸閉塞に対し，腹腔鏡と内視鏡を併用した小開腹術で胃石を全摘出した1 例を経験したので報告する．症例は5 歳女児．腹痛と嘔気のため当院紹介．腹部軽度膨満し，右側腹部に硬い腫瘤を触知．腹部造影CT 所見では腹水増量と腸管拡張を認めたため緊急手術を施行．腹腔鏡にて回腸内に異物が透見されるのが観察されたため，臍創部より閉塞部位を導出し腸管を切開して摘出したところ毛髪胃石を認めた．さらに上部消化管内視鏡で胃内に毛髪胃石が確認されたため，胃体部前壁を臍創部より引き出して切開し胃内毛髪胃石を摘出した．術後経過良好で，退院後も再発は認められていない．
Trichobezoars are formed by the ingestion of hair and by the accumulation of hair in the stomach, which can cause intestinal obstructions due to migration into the small intestine. We herein report a pediatric case of trichobezoars with small bowel obstruction, which were completely removed by laparoscope-and-endoscope-assisted surgery. A 5-year-old girl was admitted to our hospital owing to acute abdominal pain and nausea. She had mild abdominal distension, and a hard mass was detected in the right abdominal region by abdominal palpation. Abdominal CT showed ascites formation and dilated small intestine, which we considered to be indications for emergency surgery. By laparoscopic inspection, a foreign body was seen through the intestinal wall. We pulled the intestine, together with the foreign body, out from the umbilical wound of a laparoscope port. The foreign body was determined to be trichobezoars by enterotomy. Subsequently, oral upper gastrointestinal endoscopy was performed, which also showed huge trichobezoars in the stomach. After enlarging the umbilical wound, the anterior wall of the stomach was pulled out and incised, and the residual trichobezoars were removed. The postoperative course was uneventful, and the patient had no recurrence.
- Journal of the Japanese Society of Pediatric Surgeons
Journal of the Japanese Society of Pediatric Surgeons 51(7), 1205-1209, 2015
The Japanese Society of Pediatric Surgeons