胃切除後再発した胃石による回腸閉塞症―胃切除後胃石の本邦例について

Postgastrectomic Ileal Obstruction by Recurrent Phytobezoar Due to Persimmon Ingestion, Report of a Case: Bezoars after gastrectomy reported in Japan

　本邦の植物性胃石は，藤井³³⁾（1969年）の検索によれば359例に達し，その後も多数の報告がある．最近胃切除後の残胃に発生した報告^2)～4)8)9)も漸次増加しており，また胃石による腸閉塞症も多い⁷⁾⁸⁾．われわれは十二指腸潰瘍と胃石で胃切除をうけ，15年後再び胃石を生じ，小腸内へ移動し回腸閉塞症となった例を経験した．15年間に2度胃石の手術をうけた稀な例であるので文献的考察を加え，われわれが収録しえた胃切除後発生した50例（手術にて胃石摘出20例を含む）につき検討したので報告する．

　An increasing incidence of phytobezoar after gastrectomy has been reported. We have collected 50 Japanese cases of bezoars in patients who had undergone gastrectomy. Obstruction of the gastrointestinal tract requiring operation was reported in 20 patients. The jejunum was obstructed in 6 patients, stomach in 4, ileum in 2 duodenum in 1, the others in 2 and unknown in 4. Nine of these patients had Billroth Ⅰ operation, 8 had Billroth Ⅱ and 3 had other procedures. The male outnumbered female with a ratio of 18: 2. The ages varied from 29 to 69. The diseases necessitating gastrectomy were gastric ulcer in 9 patients, duodenal ulcer in 5, gastric polyp in 3, gastric cancer in 1 and the unknown in 2. Most of phytobezoars among Japanese are of persimmon origin. The non-surgical 30 patients were treated with hydrochloric acid syrup and full liquid diet. The bezoars sometimes disappeared spontaneously from the gastric remnant. In these patients the bezoars were usually found in the remnant stomach within 2 or 3 weeks after gastrectomy and they were mostly composed of glomerated foods.

　Case report: A 69-year-old woman, who had undergone gastrectomy (Billroth Ⅰ) about 15 years before because of a benign ulcer and bezoar, we admitted to hospital on Oct. 17, 1975, as an emergency with a 2-weeks-long abdominal pain after eating persimmons. The patient had suffered from subacute intestinal obstruction. She had nothing but tea for 2 weeks. At laparotomy the small intestine was distended and a sausage-shaped mass, measuring 7×4 cm, was felt in the lumen of the ileum at about 200 cm away from the ileocecal valve. The patient had confessed to eating 6 persimmons in 3 days before the onset of abdominal pain. She left the hospital in healthy condition.

　This is a very interesting case becatse bezoar did occur again 15 years after the gastrectomy for bezoar and ulcer, She had to undergo this time enterotomy on account of phytobezoar.