小児生体肝移植後に肝切離面での腸管癒着により腸閉塞を来たした1例  [in Japanese] Adhesive Small Bowel Obstruction at the Dissected Plane of a Liver Graft After Living Donor Liver Transplantation: A Pediatric Case Report  [in Japanese]

Access this Article

Search this Article

Author(s)

    • 根本 悠里 Nemoto Yuri
    • 筑波大学医学医療系小児外科 Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba
    • 新開 統子 Shinkai Toko
    • 筑波大学医学医療系小児外科 Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba
    • 田中 尚 Tanaka Nao
    • 筑波大学医学医療系小児外科 Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba
    • 相吉 翼 Aiyoshi Tsubasa
    • 筑波大学医学医療系小児外科 Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba
    • 石川 未来 Ishikawa Miki
    • 筑波大学医学医療系小児外科 Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba
    • 千葉 史子 Chiba Fumiko
    • 筑波大学医学医療系小児外科 Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba

Abstract

<p>症例は8歳女児.6歳時にシトルリン血症に対して肝左葉グラフトによる生体部分肝移植を施行された.移植後2年目に,腹痛および嘔吐で癒着性腸閉塞を発症した.腹部単純X線で右横隔膜下に拡張した腸管を認め,イレウス管を挿入し経過観察した.第8病日に症状改善し,イレウス管を抜去し食事を開始すると症状が再燃した.保存的治療による改善がなく手術適応となった.開腹時,創直下腹壁と肝切離部辺縁に結腸の強い癒着を認めた.さらに肝切離面に小腸の癒着と索状物による小腸の狭窄を認めた.結腸の癒着剥離を行い,狭窄部を含め小腸を部分切除後,端々吻合した.術中の肝血管や胆管合併症はなかった.術後経過は順調で,術後14日目に退院した.小児部分肝移植後の消化管合併症で,癒着性腸閉塞の報告は比較的少なく,本症例と同様の肝切離面による癒着から腸閉塞を来した報告は認めなかった.癒着性腸閉塞による再開腹術を避けるために,生体部分肝移植時の肝切離面による腸管との癒着防止の工夫も重要と考えられた.</p>

<p>Adhesive small bowel obstruction is a relatively rare surgical complication after liver transplantation. We report on a case of adhesive small bowel obstruction at the dissected plane of a liver graft. An 8-year-old girl was admitted to our hospital for abdominal pain and diagnosed as having a postoperative adhesive bowel obstruction. The patient had undergone living donor liver transplantation to treat citrullinemia at age 6. She was initially treated conservatively using an ileus tube; however, the bowel obstruction recurred when oral intake resumed. The patient's abdominal Computed tomography images showed that the dilated small bowel was obstructed by an adhesive band in the right upper quadrant. Emergency laparotomy was performed, and we observed a strong adhesion of that to the colon and abdominal wall. There was also marked adhesion of the small bowel to the dissected plane of the liver graft. Adhesiolysis and partial resection of the small bowel were performed. Her postoperative course was uneventful. She was discharged on postoperative day 14. Massive small bowel adhesion to the dissection plane of the liver graft can cause severe surgical complications after partial liver transplantation. To avoid re-laparotomy due to adhesive small bowel obstruction, it is necessary to apply adhesion barrier agents to the small bowel and to the dissected plane of the liver graft.</p>

Journal

  • Journal of the Japanese Society of Pediatric Surgeons

    Journal of the Japanese Society of Pediatric Surgeons 56(1), 66-70, 2020

    The Japanese Society of Pediatric Surgeons

Codes

  • NII Article ID (NAID)
    130007800591
  • NII NACSIS-CAT ID (NCID)
    AN00192281
  • Text Lang
    JPN
  • ISSN
    0288-609X
  • NDL Article ID
    030285972
  • NDL Call No.
    Z19-244
  • Data Source
    NDL  J-STAGE 
Page Top