イレウス管による医原性気胸に対し緊急胸腔鏡下手術を施行した1例

Video-assisted thoracic surgery（VATS）for a rare iatrogenic pneumothorax from ileus tube

◆要旨：イレウス管の気管内への誤挿入により気胸を生じ，胸腔鏡下手術（video-assisted thoracic surgery：以下，VATS）にて良好な経過が得られた症例を経験した．患者は68歳，男性．2006年9月，胃癌術後のイレウスにより，近医にて透視下にイレウス管を挿入中，咳嗽と呼吸困難が出現し，胸腔内へのイレウス管の逸脱を認めた．医原性気胸と診断され，当院に救急搬送された．当院にてトロッカーを挿入すると，著明な気漏を認めたため，VATSにて緊急手術を施行した．右S⁸～S⁹境界付近に損傷部を認めたが，出血はなく，損傷部を自動縫合器にて切離した．翌日，胸腔ドレーンを抜去し，術後14日目にイレウスも改善したため，退院となった．汚染が予想される医原性気胸は，VATSによる手術も有効な手段の1つと考えられた．

　We experienced a rare case of iatrogenic pneumothorax caused by an ileus tube. A 68-year-old man was admitted to our hospital due to iatrogenic pneumothorax. In September 2006,when an ileus tube was inserted for intestinal obstruction　at a nearby hospital, his lung was injured by the tube. The patient was diagnosed as having a traumatic lung injury and was referred to our hospital. Thoracic　drainage tube was inserted into the right thoracic cavity. and partial resection of the injured lung through video-assisted thoracoscopic surgery（VATS）was performed. I Operative findings revealed an injured area in the right lower lobe S 8-S 9.The chest drain was removed one day after the operation . THe patient recovered without any complication and was soon discharged. VATS is recommended as one of the treatment choices for iatrogenic pneumothorax with contamination.