腹腔鏡用ポートを使用した経胃瘻的内視鏡操作により有鉤義歯を摘出しえた1例

A case of ingested artificial tooth with clasp removed by transgastrostomic endoscopy

◆要旨：患者は60代の男性．有鉤義歯の誤飲に対し前医で内視鏡的摘出を試みたが摘出できず，CTで縦隔気腫も認め当院救急搬送となった．当院でも同様に内視鏡的摘出を試みたが困難であった．食道穿孔・裂創部に対してはクリップ縫縮やPGAフェルト被覆を行い，保存的に経過をみることとした．今後の栄養管理と有鉤義歯摘出を目的に，腹腔鏡補助下胃瘻造設術と経胃瘻的内視鏡操作による有鉤義歯摘出を行った．術後経過は良好で，術後2週目に飲水・食事を開始し，術後3週目に転院となった．経胃瘻的内視鏡操作による有鉤義歯摘出は，安全かつ比較的低侵襲な手術であり，食道穿孔をきたした義歯摘出困難例に対して有用な方法であった．

　The patient was a man in his sixties. The patient was brought to our hospital by ambulance from another clinic following unsuccessful endoscopic removal of an artificial tooth with clasp from accidental ingestion and the identification of pneumomediastinum on computed tomography （CT）. Endoscopic removal was also attempted at our hospital but its removal was difficult. Conservative management was undertaken by applying clip sutures and poly glycolic acid （PGA） felt sheets to the esophageal perforation and lacerations. For future nutritional management and removal of the artificial tooth with clasp, laparoscopic-assisted gastrostomy and transgastrostomic endoscopy were performed. Postoperative course was favorable. The patient resumed taking water and food by mouth in the second week following the surgery and was transferred to another hospital in the third week. Removal of ingested artificial tooth with clasp through transgastrostomic endoscopy was safe and relatively noninvasive, offering effective approach to complicated cases of ingested foreign bodies with esophageal perforation.