心肺停止蘇生後の虚血性小腸炎による小腸狭窄の1例  [in Japanese] A Case of Ischemic Stenosis of the Small Intestine after Cardiopulmonary Arrest  [in Japanese]

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Author(s)

    • 新里 千明 SHINZATO Chiaki
    • 国立病院機構九州医療センター消化器センター外科 Department of Gastroenterological Surgery, Clinical Research Institute, National Kyushu Medical Center
    • 坂口 善久 SAKAGUCHI Yoshihisa
    • 国立病院機構九州医療センター消化器センター外科 Department of Gastroenterological Surgery, Clinical Research Institute, National Kyushu Medical Center
    • 上原 英雄 UEHARA Hideo
    • 国立病院機構九州医療センター消化器センター外科 Department of Gastroenterological Surgery, Clinical Research Institute, National Kyushu Medical Center
    • 橋本 健吉 HASHIMOTO Kenkichi
    • 国立病院機構九州医療センター消化器センター外科 Department of Gastroenterological Surgery, Clinical Research Institute, National Kyushu Medical Center
    • 楠本 哲也 KUSUMOTO Tetsuya
    • 国立病院機構九州医療センター消化器センター外科 Department of Gastroenterological Surgery, Clinical Research Institute, National Kyushu Medical Center
    • 池尻 公二 IKEJIRI Kouji
    • 国立病院機構九州医療センター消化器センター外科 Department of Gastroenterological Surgery, Clinical Research Institute, National Kyushu Medical Center

Abstract

症例は50歳,女性.気管支喘息重責発作後に心肺停止となったが,速やかに蘇生措置が行われ救命された.その後,腹痛・下痢が長期にわたって持続し,精査により潰瘍を伴う小腸炎と診断された.保存的治療では症状の改善が得られず,検査所見としても著明な狭窄を伴うようになったため,蘇生1年4カ月後に小腸狭窄に対して腹腔鏡下小腸切除術を施行した.Treitz靱帯から約280cmの小腸に2箇所の狭窄を認め,狭窄部とその口側で拡張の強い範囲を含む80cmの小腸を切除し吻合を行った.病理学的検査では狭窄型虚血性小腸炎と診断され,臨床経過から心肺停止による循環不全から虚血をきたしたと考えられた.今回,心肺停止蘇生後に虚血性小腸炎による狭窄をきたし,外科的治療を必要とした症例を経験したので,文献的考察を含めて報告する.

A 50-year-old woman fell into cardiopulmonary arrest (CPA) due to asthmatic seizure attack, but she was successfully resuscitated by intensive treatment. Thereafter, she had suffered from abdominal pain and diarrhea for a long time, and she was diagnosed with enteritis with multiple ulcers. Because conservative treatment was unsuccesful and the examinations showed severe stenosis of the small intestine, laparoscopic resection of the small intestine was performed 16 months after CPA. There were two stenotic sites in the small intestine about 280 cm distant from the Treitz ligament. We resected an 80-cm long portion of the small intestine including the stenotic sites and severely dilated bowel proximal to the sites. Pathological examination presented stricture type of ischemic enteritis. Based on the clinical and pathological findings, we speculated that an ischemic event occurred in the small intestine during CPA that caused the stenosis. This rare case of stenosis of the small intestine due to ischemic enteritis after CPA is presented with a review of the literature.

Journal

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

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 79(4), 781-786, 2018

    Japan Surgical Association

Codes

  • NII Article ID (NAID)
    130007502345
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • ISSN
    1345-2843
  • NDL Article ID
    029042664
  • NDL Call No.
    Z19-227
  • Data Source
    NDL  J-STAGE 
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