小腸内の縫い針を腹腔鏡下手術で摘出し得た1例

A case of laparoscopic removal of swallowed needles from the gastrointestinal tract

誤飲した縫い針13本を，早期に腹腔鏡下手術などで摘出した症例を経験したので報告する．患者は61歳，女性．自殺目的で縫い針を飲んだ翌日，腹痛，咽頭痛にて入院した．胸腹部単純X線写真，CT検査で，咽頭部に2本，胃内に7本，十二指腸内に2本，小腸内に2本の針を確認した．全身麻酔下に喉頭鏡で咽頭部の針を摘出した後，トロッカーを3本挿入し，8～10mmHgで気腹した．腹腔鏡下に，小腸内の針を腸壁を貫通させて摘出した．胃，十二指腸内の針は，上部消化管内視鏡下に摘出した．術後経過は良好で，第7病日に退院した．縫い針の摘出には，必ずしも腸切除を必要とせず，本術式は非常に有効であると考えられた．

　We describe a case in which laparoscopic surgery was effective for the removal of swallowed needles. A 61-year-old woman was admitted to the hospital complaining of throat and abdominal pain after she swallowed some needles a day before admission.

　Abdominal X-ray and computerized tomography revealed two needles at the larynx, seven in the stomach, two in the duodenum and two in the jejunum. Under general anesthesia laparoscopic removal of the swallowed needles was performed after two needles at the larynx were picked up by using forceps. At first, three trocars were inserted into her abdomen, and CO2 was insufflated to the abdominal cavity with the pressure of 8 to 10 mm Hg. Needles which existed in the jejunum were removed by protruding them through the intestinal wall to the abdominal cavity using forceps. Other needles were extracted endoscopically. The postoperative course was uneventful and the patient was discharged from the hospital 7 days after the operation.

　Laparoscopic removal of swallowed needle from the intestine is feasible and should be considered before the perforation of the gastrointestinal tract occurs.