内視鏡的摘出が困難であった胸部下部食道魚骨穿孔に対して腹腔鏡下経胃的食道異物摘出術を施行し救命しえた1例

A case of laparoscopic transgastric removal of perforating esophageal fish bone in the lower thoracic esophagus

◆要旨：症例は80歳，男性．COPDと肺性心の既往がある．魚の頭を食べてから，心窩部痛を自覚し救急受診した．上部消化管内視鏡検査で胸部下部食道に真鯛の左前上顎骨を認めたが摘出できなかった．呼吸予備能が低く，胸腔鏡下手術は不耐であり，緊急に腹腔鏡下手術を施行した．食道を下縦隔より授動し胃穹窿部腹側を開窓して腹腔鏡を挿入すると胸部下部食道内に魚骨を認めた．胸部食道-胃の直線化と授動により魚骨を摘出しえた．経過良好で術後15日で退院した．検索しえた限りで腹腔鏡下に食道異物を摘出しえた初の症例であり，食道異物治療の1選択肢として有用であると考えられたので，この術式の利点と限界および要点につき報告する．

　An 80-year-old male patient with a history of chronic obstructive pulmonary disease and cor pulmonale presented to the emergency department with epigastric pain after ingesting a fish head. Upper gastrointestinal endoscopy revealed that the left premaxilla of a red sea bream was lodged in the lower thoracic esophagus, but endoscopic removal was unsuccessful. Owing to the patient's limited respiratory reserve, thoracoscopic surgery was deemed intolerable, and emergency laparoscopic surgery was performed. The esophagus was mobilized from the lower mediastinum, and an incision was made on the anterior gastric fundus to create a window for laparoscope insertion. The fish bone was visualized in the lower thoracic esophagus and successfully removed with the aid of straightening and mobilization of the lower esophagus and stomach. The postoperative course was uneventful, and the patient was discharged on postoperative day 15. To our knowledge, this is the first reported case of esophageal foreign body removal via laparoscopy. This technique is a viable option for treating esophageal foreign bodies. In this report, we discuss its advantages, limitations, and key technical points.