放射線性腸炎に合併した梅種子による食餌性イレウスに対し腹腔鏡補助下小腸切除を行った1例

Laparoscopic-assisted surgery for seed-induced small bowel obstruction with radiation enteritis : A case report

◆要旨：今回筆者らは，放射線性腸炎による小腸狭窄を誘因とした植物種子（梅種子）による食餌性イレウスに対し腹腔鏡補助下小腸切除術を施行したため報告する．患者は89歳，女性．子宮癌術後で放射線照射歴があった．嘔吐，腹痛にて発症し，腹部CTにて骨盤腔内の小腸に紡錘形の異物を認め，問診などからも梅干しの種が原因の食餌性イレウスと診断した．保存的加療にて改善せず，入院後17日目に手術を施行した．術中所見では異物存在部位の小腸は浮腫，発赤を伴い肥厚し，狭窄部の口側には固い異物を触知したため小腸部分切除術を行った．病理所見では粘膜下層にはコラーゲン沈着，硝子化を認め放射線による晩期障害に矛盾しない所見であった．

An 89-year-old woman with nausea and abdominal pain was hospitalized for small bowel obstruction. She had a past history of radiation therapy for uterine cancer. Abdominal enhanced computed tomography showed distended small intestine with wall thickening and a well-defined, round, and concentric high/ low density mass. Small bowel obstruction due to ingested Japanese apricot seed was diagnosed from medical histories. Because the symptoms did not improve with conservative treatment, operation was performed on the 17th day of hospitalization. Intraoperative findings revealed reddened and edematous intestine. A hard foreign body was palpable at the oral side of the narrowed lesion, and segmental resection including this site was performed. A hard foreign body was found to be a Japanese apricot seed. Pathologic findings showed a slight ulcer in the narrow segment. Collagen deposition and hyalinization were observed in the submucosa. These findings were consistent with the late effect of radiation, resulting in intestinal stenosis.