ビニール手袋異食に対し胃内手術が有用であった1例

Percutaneous endoscopic intragastric surgery for removal of ingested vinyl gloves : A case report

◆要旨：症例は73歳，男性．既往に統合失調症，精神発達遅滞があり，精神科病院入院中．胃瘻交換の際，偶発的に胃内異物を発見し，異物除去目的に当院紹介受診．腹部単純CT検査にて胃体部から十二指腸下降脚まで高吸収異物を認め，上部消化管内視鏡による摘出を試みるも摘出困難であった．翌日胃内手術を施行した．胃内は大量のビニール手袋で満たされており，すべて摘出した．経口内視鏡では摘出困難な異物に対し，胃内手術は必要最小限の切開で広範囲の観察および異物除去が可能なことから，腹腔鏡手術，開腹手術と比較し安全かつ有用な術式であると考えられた．

　A 73-year-old man with schizophrenia and mental retardation was referred from his psychiatric hospital for intragastric foreign bodies that had been incidentally found when replacing a gastrostomy tube. Conventional abdominal computed tomography scan showed a high density area ranging from the corpus ventriculi to the second descending part of the duodenum. First, we performed removal of the foreign bodies by upper endoscopy, but failed. The next day, we attempted percutaneous endoscopic intragastric surgery, found multiple vinyl gloves in the stomach, and removed them all. Because percutaneous endoscopic intragastric surgery, with minimal incision, enables surgeons to observe a wide area and remove foreign bodies that are difficult to remove by peroral endoscopy, it is a safe and useful technique in comparison with laparoscopic surgery and laparotomy.