柴田 佳久¹, 木浦 伸行²

Yoshihisa SHIBATA¹, Nobuyuki KIURA²

¹豊橋市民病院外科・こう門科, ²豊橋市民病院放射線技術室

¹Department of Surgery and Proctology, Toyohashi Municipal Hospital, ²Department of Radiological Technology, Toyohashi Municipal Hospital

キーワード : abdominal ultrasonograph, contrast-enhanced ultrasonograph, ileus, volvulus

腹部造影超音波検査 (造影US)にて術前診断できた成人小腸軸捻転起因の腸閉塞症を報告する. 56歳, 男性. 2001年8月18日下痢・嘔吐と腹痛が突然出現した. 腹痛は強度で腹膜刺激徴候もみられた. 腹部X線写真で腸閉塞を疑い, 腹部超音波検査で腹水と腸管壁虚血を思わせる拡張腸管が観察された. 造影USにて腸管壁の血流シグナルの増強とwhirlpool signが観察されたことから小腸軸捻転症による絞扼初期の腸閉塞と診断し手術を施行した. 総腸間膜症に伴う小腸軸捻転であったが解除にて腸管虚血は可逆性で腸切除を要さなかった. 造影USにて腸閉塞状態や軸捻転症の特徴所見が明確に描出され術前に病態把握が可能であった. 造影USは腸閉塞症例においても腸管虚血などの判断や病態把握がより明瞭化されるため有効な検査と考える.

A 56 year old male patient with diarrhea, vomiting, and severe abdominal pain was hospitalized to our institution. Plain x-ray films showed obstruction of the small bowel; ultrasonography, peritoneal fluids and a dilated intestine with thicken walls; and contrast-enhanced ultrasonography, a clear whirlpool sign. These findings led to a diagnosis of intestinal volvulus with ischemic change, and emergency surgery was carried out. Intestinal ischemia of the loop was found at laparotomy. Because of the viability of the intestine after the volvulus was untwisted, however, intestinal resection was not necessary. Contrastenhanced ultrasonography may prove valuable in diagnosing intestinal volvulus and small-bowel obstruction with or without vascular flow in the intestinal walls.