腹腔鏡下に治療した胃石を伴うイレウスの1例

A case of intestinal obstruction due to bezoar operated with laparoscopic surgery : A case report

◆要旨：患者は79歳，女性．腹痛と嘔吐を主訴に近医を受診し，多発性胃潰瘍との診断でproton pump inhibitorsを投与されたが症状が改善せず当院紹介となった．治療中に嘔吐症状の再燃を認めた．上部内視鏡検査で胃石を認めたため，溶解療法を施行した．その後，胃内に胃石が残存し，小腸へ移動した胃石がイレウスを呈し，イレウス管挿入による保存的治療に抵抗性であったため手術適応と判断した．溶解療法後6日目に，腹腔鏡下の胃前壁切開による胃石摘出および回腸末端の胃石の鉗子による破砕を施行した．術後経過は良好で，術後第10病日に退院となった．内科的治療に抵抗性の胃石および胃石に伴うイレウスに対して，腹腔鏡下手術は有用な選択肢の1つになりうると考えられた．

The patient was a 79-year-old female. She visited the hospital with the chief complaint of abdominal pain and vomiting. Gastric endoscopy revealed multiple gastric ulcers and she was treated with oral proton pump inhibitors（PPI）. She was referred to our hospital and follow-up gastric endoscopy revealed bezoar in the stomach. After dissoluting the bezoar, some parts of bezoar had passed into the small intestine, causing ileus. We performed laparoscopic surgery to remove the bezoar after conservative observation for 6 days. At the operation, we crushed the bezoar in the terminal ileum using forceps and removed the bezoar in the stomach by anterior wall incision. The postoperative course was good and the patient discharged from our hospital on the 10th postoperative day. We considered that laparoscopic surgery can be safely performed and should be considered as a treatment option for ileus associated with bezoar resistant to medical therapy.