外傷性遅発性小腸狭窄に対し腹腔鏡補助下手術を施行した1例:―単孔式腹腔鏡補助下イレウス手術における術中消化管減圧の工夫― A Case of Late-Onset Intestinal Stenosis Associated With Perforated Peritonitis Following Blunt Abdominal Trauma Treated by Laparoscopic-Assisted Surgery

この論文にアクセスする

この論文をさがす

著者

抄録

<p>症例は9 歳女児.交通事故により受傷し,前医で骨盤骨折に対し加療された.受傷後5 日目より経口摂取を開始したがイレウス症状を反復した.同6 週目に腹部膨満に加え発熱をきたし当科紹介となった.腹部造影CT 検査で腸管の拡張と骨盤内膿瘍を認め,臍部小切開による腹腔鏡補助下手術を行った.腸管拡張が強かったため,最初に臍部創から小腸を引き出し,術前に挿入しておいたイレウス管を操作し腸管を減圧した.その後腹腔鏡下に観察したところ右下腹部前腹壁と回腸との癒着が判明し,これを剥離・授動し創外に脱転すると腹壁と癒着していた箇所に腸間膜の欠損を伴う全周性狭窄を認めたため同部位を切除した.術後経過は順調で,術後13 日目に骨盤骨折の治療のため前医へ転院した.鈍的腹部外傷後の遅発性小腸狭窄によるイレウスは診断に苦慮することがあるが,臍部を用いた単孔式腹腔鏡補助下手術は安全に施行でき,診断にも治療にも有用であった.</p>

<p>A 9-year-old girl was run over by a truck and brought to a previous hospital. An external skeletal fixation was performed for her pelvic fracture. Although oral intake started postinjury day 5, she had been suffering from repeated intestinal obstruction since then. At 6 weeks after the injury, she was referred to our hospital because she had fever in addition to intestinal obstruction symptoms. An urgent enhanced computed tomography scan revealed a dilated intestine and pelvic abscess. She underwent laparoscopic-assisted surgery with minilaparotomy. Before the laparoscopic procedure, intestinal decompression was performed by handling the intestine through the wound at the umbilicus. Then, we found a mesenteric defect with severe stenosis of the ileum. The affected bowel segment was resected, and primary anastomosis was performed. The patient was transferred to the previous hospital 13 days later with normal bowel function for further treatment of her pelvic fracture. Although posttraumatic intestinal stenosis is a rare condition and difficult to diagnose, laparoscopic-assisted surgery could be feasible and useful for the diagnosis and treatment of intestinal obstruction even with a dilated intestine and peritonitis.</p>

収録刊行物

  • 日本小児外科学会雑誌

    日本小児外科学会雑誌 52(7), 1337-1341, 2016

    特定非営利活動法人 日本小児外科学会

各種コード

  • NII論文ID(NAID)
    130005251387
  • NII書誌ID(NCID)
    AN00192281
  • 本文言語コード
    JPN
  • ISSN
    0288-609X
  • NDL 記事登録ID
    027804431
  • NDL 請求記号
    Z19-244
  • データ提供元
    NDL  J-STAGE 
ページトップへ