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鈍的腹部外傷後の小腸狭窄症：1 症例報告
Small bowel stenosis after blunt abdominal trauma: a case report.
PMID: 32458201 PMCID: PMC7251019. DOI: 10.1186/s40792-020-00874-1.
抄録
背景:
鈍的腹部外傷後の小腸狭窄は比較的まれであり、外傷から腸狭窄への進行が遅れることがある。ここでは、比較的早期に小腸狭窄症と診断され、腹腔鏡手術を受けた患者の症例を報告する。
BACKGROUND: Small bowel stenosis after blunt abdominal trauma is relatively rare, and progression from trauma to bowel stenosis might sometimes be delayed. Herein, we report the case of a patient who was diagnosed with small bowel stenosis relatively early and received laparoscopic surgery.
症例紹介:
18歳の日本人男性が交通事故に遭い、緊急に当院に搬送された。到着時に右腎・右副腎損傷と腹部大動脈瘤で入院した。入院13日目に手術をせず保存的治療中に嘔吐し、CT検査で小腸狭窄と口腔側小腸の拡張が認められた。イレウスチューブによる改善は認められず，入院21日目に腹腔鏡下手術を受けた。腹腔内を腹腔鏡で簡単に観察した。腸間膜はうっ血しており、狭窄小腸部周辺に瘢痕が認められ、トレイツ靭帯から40～50cmの位置に3箇所の狭窄部が認められた。小腸の部分切除と吻合を行った。術後経過は安定しており、術後8日目に退院した。
CASE PRESENTATION: An 18-year-old Japanese male was in a traffic accident and was urgently transported to our hospital. On arrival, he was admitted with right kidney and right adrenal injury and abdominal aortic aneurysm. On hospital day 13, he vomited during conservative treatment without surgery, and computed tomography revealed small bowel stenosis and dilatation of the oral-side small bowel. No improvement with the ileus tube occurred, and he received laparoscopic surgery on hospital day 21. Briefly, the abdominal cavity was observed with a laparoscope. The mesentery was congested, scarring around the stenotic small bowel regions was present, and three stenotic regions were observed 40-50 cm from the Treitz ligament. The patient received partial resection and anastomosis of the small bowel. The postoperative course was stable, and he was discharged on postoperative day eight.
結論:
腹部外傷後の腸管狭窄症のほとんどの症例は不可逆的であり、通常は外科的治療が必要である。したがって、鈍的な腹部外傷後の腹部症状を有する患者では、小腸狭窄症を考慮すべきである。
CONCLUSIONS: Most cases of bowel stenosis after abdominal trauma are irreversible and usually require surgical treatment. Therefore, small bowel stenosis should be considered in patients with abdominal symptoms after blunt abdominal trauma.