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Journal of Medical Ultrasonics

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1995 - Vol.22

Vol.22 No.06

Case Report(症例報告)

(0483 - 0487)

ロングチューブ留置が発症の原因と考えられた開腹術後成人型腸重積症の1例 −腹部超音波検査の有用性について−

A Case of Adult Intussusception After Laparotomoy, Apparently Caused by Long Intestinal Tube: The Usefulness of Ultrasonography

三木 康彰1, 角村 純一1, 水谷 伸1, 吉岡 泰彦1, 佐々木 隆士1, 門田 治1, 永井 勲1, 田中 智之2, 竹中 正人3, 中戸 洋行3, 山本 忠生4

Yasuaki MIKI1, Jyunichi SUMIMURA1, Shin MIZUTANI1, Yasuhiko YOSHIOKA1, Takasi SASAKI1, Osamu MONTA1, Isao NAGAI1, Tomoyuki TANAKA2, Masato TAKENAKA 3, Hiroyuki NAKATO3, Tadao YAMAMOTO4

1社会保険紀南綜合病院外科, 2社会保険紀南綜合病院病理部, 3社会保険紀南綜合病院生理機能検査部, 4社会保険紀南綜合病院内科

1Department of Surgery, Kinan General Hospital , 2Department of Pathology, Kinan General Hospital , 3Department of Physiological Examination, Kinan General Hospital , 4Department of Internal Medicine, Kinan General Hospital

キーワード : Complication of long intestinal tube, Ileus, Intussusception, Ultrasonography

A case of postlaparotomy jejunal intussusception that was apparently caused by a long initestinal tube (LT) is reported here. The patient, a 74-year-old man who had been admitted to this institution because of adhesive ileus after the LT was inserted, had a history of distal gastrectomy for early gastric cancer two years earlier. The adhesions was separated, and the ileum was partially resected, but the LT was left in the jejunum for postoperative bowel decompression. The LT was removed immediately on the third postoperative day, however, when intermittent vomiting and left upper abdominal pain occurred. Conservative treatment was performed, and the patient was kept under observation. Although fluid levels were not discernible in abdominal x-ray films, ultrasonography showed intussusception where the tip of the LT had been located. Intestinal peristalsis and Kerckring's folds had both disappeared, and the pseudo-kidney sign was detected on repeat ultrasonography. Also, the swollen, strangulated bowel wall was thickened and had low echogenicity accompanied by several high spots. These findings were considered to result from jejunal ischemia caused by intussusception, so laparotomy was performed on the fortieth postoperative day. An antegrade intussusception 15 cm long and located 20 cm from the origin of the jejunum was found on surgery. Because the intussusception was associated with ischemia and necrosis, the affected bowel was resected and end-to-end anastomosis was performed. The patient's postoperative progress was good. This intussusception was attributed to the LT that had entered the jejunum without deflation of the balloon and had been fixed at the patient's nose. Abdominal ultrasonography proved useful in making the diagnosis and in determining the treatment.