内視鏡的胃瘻造設術の小腸間膜誤穿刺によるイレウスに対して腹腔鏡下手術を行った1例

A case of laparoscopic surgery for ileus caused by misplacement of percutaneous endoscopic gastrostomy passed through the mesentery of the small bowel

◆要旨：患者は73歳，男性．被殻出血による仮性球麻痺の後遺症のため他院で内視鏡的胃瘻造設術を施行された．8か月後に腸閉塞による誤嚥性肺炎を発症し入院となった．CT検査で胃瘻に向かう小腸間膜の渦巻き像を，イレウス管造影で胃瘻造設部に向かって小腸の不完全狭窄像を認めたため，癒着性イレウスの診断で腹腔鏡下手術を行った．手術所見で胃瘻が小腸間膜を貫いて造設されていたことを確認したため，瘻孔を切除，胃瘻を抜去し，腸閉塞の原因を解除した．そのまま腹腔鏡下で胃瘻を再造設した．胃瘻穿刺における合併症に起因した腸閉塞に対し，腹腔鏡下手術は低侵襲で原因検索を行い，治療を行える有用な手段と考えられた．

This is a case showing the efficiency of laparoscopic surgery for ileus caused by misplacement of percutaneous endoscopic gastrostomy（PEG）. A 73-year-old man underwent PEG because of pseudobulbar palsy by putamen hemorrhage at the former hospital. Eight months later, he was admitted to our hospital with a diagnosis of aspiration pneumonia due to ileus. Abdominal CT indicated a whirl sign near PEG. Contrasting image from intestinal tube indicated obstruction of small bowel at the narrowing to PEG. Laparoscopic operation revealed that PEG was placed, passing through the mesentery of the small bowel. After dividing the fistula, the PEG was renewed. Laparoscopic surgery is an efficient and minimally invasive treatment for ileus caused from PEG complication.