腹腔鏡補助下手術にて回収しえた誤飲5年後の小腸内異物（義歯）の1例

A foreign body（dental prosthesis）in the small intestine removed by laparoscopic surgery 5 years after accidental swallowing : a case report

◆要旨：約5年前に義歯を誤飲したために当院を受診した．小腸内に異物を認めていたが，症状を認めなかったため自然排出を期待して様子を観察していた．その後自覚症状を認めなかったために来院されず放置していたが，5年後の今回，泌尿器科処置が必要となり術前検査にて小腸内に異物を確認した．処置に支障をきたす可能性があったため，まず小腸内視鏡下に回収を試みたが金具の粘膜への陥入にて回収は困難であった．そこで外科的回収処置を要したため，腹腔鏡補助下小腸部分切除にて回収した．鋭利な異物であったために，小腸粘膜に陥入して肉芽を形成していた．無症状の異物回収術に対しては異論があると思われるが，必要性を認めた場合は可能な限り侵襲の少ない手術を行う必要があると思われた．

　The patient visited our hospital 5 years ago due to accidental swallowing of a dental prosthesis. The prosthesis was confirmed in the small intestine. However, since there were no symptoms, the patient was observed, expecting for the dental prosthesis to be excreted spontaneously. Subsequently, the patient did not seek medical care because of the lack of symptoms. After 5 years, treatment in the urological department became necessary, and preoperative examination confirmed the foreign body to still be present in the small intestine. Since it was possible that the prosthesis was an obstacle to the treatment, its removal under the guidance of laparoscopy of the small intestine was attempted. However, removal was difficult due to the impaction of the metal fitting in the mucosa. Therefore, the prosthesis was removed by laparoscopy-assisted partial resection of the small intestine. The sharp prosthesis had been impacted in the mucosa of the small intestine, showing granulation. Opinions may be divided on the removal of foreign bodies in asymptomatic patients. However, when removal is necessary, minimally invasive surgery should be performed.