内容紹介
Summary
A 72-year-old man presented to our hospital with a chief complaint of constipation and hiccup. Computed tomography revealed a colonic obstruction due to descending colon cancer, and a transnasal ileus tube was inserted. On the 2nd day of hospitalization, we attempted transanal drainage, but it was difficult to cannulate. Abdominal findings and inflammatory response were normal; thus, the transanal drainage procedure was followed by only decompression with a transnasal ileus tube. On the 13th day of hospitalization, the tip of the ileus tube reached the vicinity of the occluded area. We performed a one-stage resection and anastomosis procedure. The patient was discharged from the hospital on the 16th postoperative day. Patients with left-sided colorectal cancer ileus are often immediately treated with colostomy when trans-anal decompression is difficult. We report a case of one-stage resection and anastomosis procedure for a descending colon cancer ileus after decompression with a transnasal ileus tube.
要旨
症例は72歳,男性。吃逆と便秘を主訴に当院を受診した。腹部CTで下行結腸腫瘍に伴うイレウスの診断で,同日に経鼻的イレウス管を挿入した。入院2日目に経肛門的ドレナージを試みたがカニュレーション困難であった。緊急手術による減圧治療も考慮したが腹部所見は乏しく,採血データでも炎症反応の悪化なども認めなかったため口側からの減圧のみで経過観察をした。イレウス管先端は入院5日目にバウヒン弁を越え結腸内まで,13日目には閉塞部付近にまで先端が到達していた。減圧が良好のまま入院14日目に一期的に根治切除および吻合術を行った。麻痺性イレウスが遷延したが,術後16日目に退院となった。左側結腸癌に伴うイレウスは経肛門的な減圧が困難な場合には人工肛門を作製し,二期的な手術が必要になる場合が多いが,経鼻的イレウス管で一期的に根治手術が可能であった1例を経験したので報告する。
目次
A 72-year-old man presented to our hospital with a chief complaint of constipation and hiccup. Computed tomography revealed a colonic obstruction due to descending colon cancer, and a transnasal ileus tube was inserted. On the 2nd day of hospitalization, we attempted transanal drainage, but it was difficult to cannulate. Abdominal findings and inflammatory response were normal; thus, the transanal drainage procedure was followed by only decompression with a transnasal ileus tube. On the 13th day of hospitalization, the tip of the ileus tube reached the vicinity of the occluded area. We performed a one-stage resection and anastomosis procedure. The patient was discharged from the hospital on the 16th postoperative day. Patients with left-sided colorectal cancer ileus are often immediately treated with colostomy when trans-anal decompression is difficult. We report a case of one-stage resection and anastomosis procedure for a descending colon cancer ileus after decompression with a transnasal ileus tube.
要旨
症例は72歳,男性。吃逆と便秘を主訴に当院を受診した。腹部CTで下行結腸腫瘍に伴うイレウスの診断で,同日に経鼻的イレウス管を挿入した。入院2日目に経肛門的ドレナージを試みたがカニュレーション困難であった。緊急手術による減圧治療も考慮したが腹部所見は乏しく,採血データでも炎症反応の悪化なども認めなかったため口側からの減圧のみで経過観察をした。イレウス管先端は入院5日目にバウヒン弁を越え結腸内まで,13日目には閉塞部付近にまで先端が到達していた。減圧が良好のまま入院14日目に一期的に根治切除および吻合術を行った。麻痺性イレウスが遷延したが,術後16日目に退院となった。左側結腸癌に伴うイレウスは経肛門的な減圧が困難な場合には人工肛門を作製し,二期的な手術が必要になる場合が多いが,経鼻的イレウス管で一期的に根治手術が可能であった1例を経験したので報告する。