学術雑誌論文 [症例] 完全腹腔鏡下手術で治療しえた外傷性空腸穿孔の1例
[CASE REPORT] Laparoscopic surgery for a traumatic perforation of the small intestine : a case report

間宮, 俊太  ,  仲本, 嘉彦  ,  鈴木, 洋一  ,  泉對, 貴子  ,  服部, 陽  ,  三上, 隆一  ,  松井, 郁一  ,  長田, 俊一  ,  松田, 充宏  ,  松葉, 芳郎

93 ( 5 )  , pp.195 - 200 , 2017-10-01 , 千葉医学会
ISSN:0303-54762433-4243
NII書誌ID(NCID):AN00142148
内容記述
[要旨] 症例は73歳女性。軽自動車で交差点を右折中に直進車と衝突し受傷,右肩痛,左膝痛,軽度腹痛を訴え当院へ救急搬送となった。腹部に外傷を認めず,腹痛も軽度であったが,胸部単純レントゲン検査で腹腔内遊離ガス像が認められ,腹部CT検査を経て外傷性空腸穿孔の診断に至った。全身状態が安定しており,肝臓や腎臓などの実質臓器損傷が否定的で,損傷部位が左上腹部の小腸にある程度同定できていたため腹腔鏡下手術の方針とした。Treitz 靭帯から約15㎝の空腸に日本外傷学会消化管損傷分類Ⅱa型に相当する径15㎜大の穿孔を認め,鏡視下に穿孔部を全層縫合閉鎖した。術後経過は順調で,術後第2病日より経口摂取開始,第8病日に軽快退院した。外傷性小腸穿孔に対しては,全身状態が落ち着いていれば診断的腹腔鏡を行い,損傷が軽度であれば引き続き完全腹腔鏡下手術を行うことも有用であると考えられた。
[SUMMARY] A 73-year-old woman was admitted to our hospital after a traffic accident.She complained right shoulder pain, left knee pain, and mild abdominal pain, but no trauma was found in the abdomen. Even though the abdominal pain was mild, chest X-ray examination revealed a pneumoperitoneum which led to the diagnosis of traumatic jejunal perforation after an abdominal CT scan. Since her general condition was stable and the organ damage to the liver, kidney, and spleen was negative, and the injured site was estimated to exist in the small intestine of the left upper abdominal region, laparoscopic surgery was performed. The rupture site was the upper part of the jejunum, about 15 cm from the Treitz’ ligament, with a diameter of 15 mm. The injury severity degree was evaluated to grade Ⅱa, according to the Japanese trauma association gastrointestinal damage classification. The perforation was sutured laparoscopically. There were no postoperative complications, starting oral ingestion from the 2nd postoperative day and she was discharged on the 8th postoperative day. For traumatic small bowel perforation, it was considered useful to carry out a diagnostic laparoscope in a stable condition, and to perform total laparoscopic surgery subsequently when the damage is mild.
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http://opac.ll.chiba-u.jp/da/curator/104400/93-5-195.pdf

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