tension gastrothoraxを来した遅発性横隔膜ヘルニアの周術期管理経験

Perioperative Management of Late-onset Congenital Diaphragmatic Hernia in an Infant with Tension Gastrothorax

要旨

　tension gastrothorax（緊張性胃胸）は，胸腔内に脱出した胃に食道胃接合部のねじれと胃流出路閉塞が出現することで胃が過度に拡張し，呼吸障害や縦隔偏位を来す病態であり，初診時対応が遅れると重篤な経過をたどりうる。われわれは，tension gastrothoraxを来した遅発性横隔膜ヘルニア患児の周術期管理を経験し，低酸素脳症の合併を疑われたが，早期診断と治療介入により後遺症なく管理しえた。

　Tension gastrothorax（TGT）is associated with late-onset diaphragmatic hernia and can lead to a serious course if the initial diagnosis is delayed. We report the case of a child with late-onset congenital diaphragmatic hernia who had TGT. The patient was a 2-month-old boy diagnosed with a diaphragmatic hernia. Gastric dilatation decreased with gastric tube positioning and suctioning, and a wait-and-see procedure was to be performed. In addition, hypoxic encephalopathy was suspected based on CT findings, and brain protection therapy was initiated. Anesthesia was performed with neuromonitoring, and the patient was discharged postoperatively with no abnormality revealed by imaging studies.