外傷性壁内血腫による空腸の通過障害をきたした6歳男児に対し，腹腔鏡下に血腫除去を行った1例

Laparoscopic surgery for traumatic jejunal wall hematoma in a 6-year-old boy

◆要旨：症例は成長発達に問題のない6歳，男児．ペダルなし自転車で転倒した際にハンドルで心窩部を強打し受傷．同日より腹痛と嘔吐を認めた．CTでTreitz靱帯近傍の空腸の壁内に血腫を認め，それに伴う通過障害をきたしていた．禁食で経過をみていたが水分摂取でも嘔吐があり，保存的治療継続困難と判断し第11病日に手術を行った．腹腔鏡下に空腸を切開して血腫の吸引を行った．術中に内腔の通過障害の有無を確認し，切開部位を縫合して手術を終了した．術後は12日目に退院となった．保存的治療を選択した場合でも手術時期を逸することのないよう，慎重な経過観察が必要であると考えられた．また，腹腔鏡下に血腫除去を行い，良好な結果を得ることができた．

　The patient is a 6-year-old boy who fell from the bicycle and hit his epigastrium with the steering wheel. On the same day, he developed abdominal pain and vomiting. Computed tomography revealed a hematoma in the wall of the jejunum near the Treitz ligament, which resulted in intestinal obstruction. He was treated conservatively by fasting. However, because he started vomiting with only water intake, surgery was performed on hospitalization day 11. Laparoscopically, the incision was made in the jejunum and the hematoma was aspirated. During surgery, intestinal obstruction in the lumen was confirmed, and the incision site was sutured to complete the surgery. The patient was discharged on postoperative day 12 without any complication. The patient should be monitored carefully even during conservative treatment so that surgery may be performed timely.