腹腔鏡補助下に手術を施行した胃石による小腸閉塞の1例

Laparoscopy-assisted surgery for a patient with small bowel obstruction caused by a bezoar

症例は64歳，女性．腹痛，嘔吐を主訴に紹介となり，精査中に腸閉塞を発症した．挿入したイレウス管からの小腸造影検査にて，境界明瞭な楕円形腫瘤を認めた．腹部CT検査では小腸に径3cm大の内部に少量のガスを含んだ海綿状腫瘤を認めたため，胃石による小腸閉塞と診断した．手術は腹腔鏡補助下に行った．術中所見ではイレウス管先端より20cm肛門側の小腸に鶏卵大の腫瘤を認めた．同部位が閉塞起点と判断し，右傍腹直筋切開を4cm加え，腫瘤部位の小腸を体外に誘導した．腫瘤部位を切開し，約4cmの胃石を摘出した．経過は良好で術後10日目に退院した．胃石による小腸閉塞の手術方法として腹腔鏡補助下手術が有用な治療法の1つと考えられた．

　The patient was a 64-year-old woman who presented with abdominal pain and vomiting as chief complaints. The patient was referred to our hospital and developed intestinal obstruction while undergoing thorough testing. A small bowel series performed through an intestinal tube confirmed an elliptical mass with clear borders. Abdominal computed tomography showed a 3-cm spongy mass including a small quantity of gas in the small intestine. Small bowel obstruction caused by a bezoar was soon diagnosed. Surgery was performed with laparoscopic assistance. A chicken egg-sized mass was seen in the small intestine 20 cm anal to the tip of the intestinal tube. Based on the supposition that this was the starting point of obstruction, a 4-cm incision was placed in the right rectus abdominis muscle to exteriorize the section of small intestine containing the mass. An incision was placed in the area, and a bezoar about 4 cm in diameter was removed. The postoperative course was uneventful and the patient was discharged on the tenth postoperative day. Laparoscopy-assisted surgery is a useful therapeutic option for small bowel obstruction caused by a bezoar.