腹腔鏡下虫垂切除術後，落下ステイプル針によりイレウスをきたした1例

A case of ileus caused by slipped down staple used for laparoscopic appendectomy

◆要旨：患者は34歳，女性．2011年12月，繰り返す虫垂炎に対しlaparoscopic interval appendectomyを施行した．虫垂根部は自動縫合器で切離した．第7病日，食後の腹痛，嘔吐にて外来を受診し，術後イレウスの診断で再入院となった．イレウス管を挿入したが改善は乏しく，第14病日に腹腔鏡下イレウス解除術を施行した．手術所見としては，自動縫合器の落下ステイプルを核としたbandを認め，腸管が入り込んでイレウスを呈していた．自動縫合器の落下ステイプルを原因としたイレウスは稀な合併症ではあるが，可能性は十分にありうる．そのために，余分なステイプル針を腹腔内に残存させないことが重要である．また，不必要な自動縫合器の使用を控えることも重要であると考えられる．

A patient is a 34-year-old woman who underwent laparoscopic interval appendectomy for repeated appendicitis in December 2011. Appendix was resected with a linear stapler. She re-visited the hospital, seven day after surgery, because of abdominal pain, vomiting after meal ; she was re-hospitalized with a diagnosis of post-operative ileus. An ileus tube was inserted, but because her condition did not improve, laparoscopic operation for ileus was performed 14 days after the initial surgery. Operative findings revealed a band due to slipped down staple with intestinal protrusion, causing ileus. Ileus due to slipped down staple of a linear stapler is possible, though rare. It is important not to allow an extra staple to remain in the intraperitoneal space. Moreover, refraining from excess use of linear stapler may also be important.