腹腔鏡補助下に解除した食道癌術後腸瘻に起因した内ヘルニアによるイレウスの1例

Laparoscopic lysis for a patient with jejunostomy-related internal hernia following radical esophagectomy : a case report

◆要旨：食道癌術後に発症した腸瘻に起因した内ヘルニアによるイレウスに対し，腹腔鏡補助下解除術を施行した1例を報告する．患者は58歳，男性で嘔気，嘔吐を主訴に入院した．4か月前に胸部食道癌に対して開胸食道切除術，後縦隔経路胃管再建術，腸瘻造設術の既往があった．胸腹部骨盤部CT検査で胃管・十二指腸から上部空腸の著明な拡張と，腸瘻を中心とした腸間膜の渦巻き様所見を認めた．腸瘻に起因した内ヘルニアによるイレウスと診断し手術を施行した．3ポート気腹法で，内ヘルニアの解除と小腸部分切除を行った．術後経過は順調で術後10病日で退院した．本症例は術前CTで腸管の閉塞部位の診断が可能で，手術適応の判断やポートの位置決めなどが容易であった．

We report here a case of laparoscopic lysis of jejunostomy-related internal hernia following radical esophagectomy. A 58-year-old Japanese man was admitted to our hospital with severe nausea and vomiting. He had a history of radical esophagectomy with gastric tube reconstruction and tube jejunostomy for thoracic esophageal cancer four months ago. Chest-abdomino-pelvic enhanced CT revealed a markedly dilated gastric pull-up, duodenum and upper jejunum and whirl sign with centering jejunostomy. These findings were compatible with internal hernia occurring at the jejunostomy site. Emergency laparoscopic lysis and partial resection of the jejunum was undergone using the pneumoperitoneal method with three ports. The patient's postoperative course was uneventful and he was discharged 10 days after the operation. This case was easily diagnosable by preoperative CT as jejunostomy-related internal hernia, with the decision to operate and optimal site of port insertion also straightforward.