ENBD逸脱による空腸穿孔に対し消化管内視鏡併用腹腔鏡手術により治療した1例

A case report : A perforation of the jejunum caused by the dislocation of a endoscopic naso-biliary drainage tube treated by laparoscopy and endoscopy cooperative surgery

◆要旨：患者は73歳，男性．胆管炎の診断で入院となり内視鏡的経鼻胆管ドレナージ（以下，ENBD）チューブを留置した．入院3日目にX線撮影でチューブの逸脱が確認されたため抜去した．抜去後より腹痛を生じ，悪化傾向にあったため，翌日CTを撮影したところfree airを認めた．逸脱したチューブの先端による消化管穿孔と考え，緊急手術を行った．消化管内視鏡観察下に腹腔鏡下手術を行い，空腸の穿孔部を同定したうえで，小開腹による穿孔部縫合・大網被覆術を行った．術後は表層創感染を認めたのみで術10日後に退院となった．ENBD逸脱による腸管穿孔は非常に稀な合併症であるため報告する．

　A 73-year-old man was admitted to our hospital for the treatment of cholangitis. We placed an endoscopic naso-biliary drainage tube in the common bile duct. Three days later, an abdominal plain X-ray showed dislocation of the tube and it was, therefore, removed. The patient experienced abdominal pain, which gradually worsened. The next day, computed tomography revealed intraabdominal free air. We believed that the dislocated drainage tube had caused gastrointestinal perforation. Laparoscopic surgery with endoscopic observation was performed. A perforation of the jejunum was promptly detected, which necessitated irrigation of the intra-abdominal cavity with saline solution and repair by suturing with an omental patch through a small incision. Although superficial surgical site infection subsequently occurred, the patient was eventually discharged from our hospital 10 days after the surgery. We present this case report to highlight a rare complication.