腹腔鏡補助下幽門側胃切除後の胃石による小腸イレウスに対する腹腔鏡補助下胃石除去術の1例

Bezoar-inducted small bowel obstruction after laparoscopy-assisted distal gastrectomy treated by laparoscopic surgery : a case report

◆要旨：患者は58歳，男性．腹痛と嘔吐を主訴に当院を紹介され受診し,イレウスの診断にて入院となった．胃癌に対し，4年前に腹腔鏡補助下幽門側胃切除術の既往があった．腹部CTで残胃内と閉塞起点の小腸内に含気性の腫瘤を認め,胃石の落下による小腸イレウスが疑われた．入院後イレウス管を留置して腸管減圧を図ったが,胃内腫瘤は小腸へ移動し, 小腸内の腫瘤は停留していたため，腹腔鏡下手術の方針となった．腹腔鏡下に回盲部から約50cmと80cmの回腸に鶏卵大の膨隆を認めたため，虫垂炎手術創上に4cmの小切開を行い，回腸を体外に引き出して腸切開により胃石を摘出した．術後は順調に経過し，術後第9病日に退院となった．

　A 58-year-old man who had undergone laparoscopy assisted distal gastrectomy for gastric cancer 4 years ago was admitted to our hospital with the chief complaints of abdominal pain and vomiting. Computed tomography revealed a gas-containing foreign body in the remnant stomach and another one at the obstructed portion of the ileum. A diagnosis of small intestinal obstruction induced by a bezoar was made. After the treatment by ileus decompression tube, the bezoar in the remnant stomach migrated to the small intestine, and the other remained in the small intestine. A laparoscopy assisted operation was performed. Two chicken egg- sized masses were observed at50cm and 80cm oral side from the terminal ileum. A 4cm incision was made along the appendectomy scar and the section of the ileum containing the two masses was exteriorized. The bezoars were removed by enterotomy. The postoperative course was uneventful and the patient was discharged on the ninth postoperative day.