内容紹介
Summary
Abdominal computed tomography(CT)revealed ileus due to sigmoid colon cancer in a 68-year-old man with abdominal pain, and endoscopic decompression using a transanal ileus tube was attempted. The blood test on the following day showed a marked increase in CRP 46.13 mg/dL. Abdominal contrast CT was performed, and mesenteric ischemia was confirmed. Emergency surgery was performed on the same day. The ileum, and ascending, transverse, and descending colon appeared mottled and necrotic and were excised. A specialized diet started on the 5th postoperative day, and parenteral nutrition was used for a long period of time, due to the possibility of short bowel syndrome. The ileostomy and colostomy was closed 57 days after the operation. The patient finished parenteral nutrition on the 88th postoperative day without obvious nutritional absorption disorder and was discharged on the 94th postoperative day as oral intake only. We reported a case of ileus due to colon cancer with non-occlusive mesenteric ischemia(NOMI).
要旨
症例は68歳,男性。腹痛を主訴に当院に救急搬送された。腹部CTでS状結腸に不整な壁肥厚を認め,それより口側腸管に著明な拡張を認めた。S状結腸癌による大腸イレウスの疑いで,下部消化管内視鏡下に経肛門的イレウス管を留置し入院となった。翌日の血液検査でCRP 46.13 mg/dLと著明な上昇を認め,造影CTで左側小腸,下行結腸の腸管壁に造影効果の減弱を認め,腸管虚血が疑われため緊急手術を行った。回腸(Treitz靱帯より130 cm)から下行結腸に非連続性の腸管の壊死所見を認め,回腸からS状結腸までの腸管切除,人工肛門・粘液瘻造設術を施行した。術後5日目より食事開始,短腸症候群の可能性を考慮し静脈栄養を長期に併用しつつ栄養管理を行った。術後57日目に人工肛門を閉鎖し,明らかな栄養吸収障害はなく術後88日目で静脈栄養を終了し,経口摂取のみとして術後94日目に退院となった。大腸癌イレウスによる非閉塞性腸管虚血(NOMI)を発症した1例を経験したので報告する。
目次
Abdominal computed tomography(CT)revealed ileus due to sigmoid colon cancer in a 68-year-old man with abdominal pain, and endoscopic decompression using a transanal ileus tube was attempted. The blood test on the following day showed a marked increase in CRP 46.13 mg/dL. Abdominal contrast CT was performed, and mesenteric ischemia was confirmed. Emergency surgery was performed on the same day. The ileum, and ascending, transverse, and descending colon appeared mottled and necrotic and were excised. A specialized diet started on the 5th postoperative day, and parenteral nutrition was used for a long period of time, due to the possibility of short bowel syndrome. The ileostomy and colostomy was closed 57 days after the operation. The patient finished parenteral nutrition on the 88th postoperative day without obvious nutritional absorption disorder and was discharged on the 94th postoperative day as oral intake only. We reported a case of ileus due to colon cancer with non-occlusive mesenteric ischemia(NOMI).
要旨
症例は68歳,男性。腹痛を主訴に当院に救急搬送された。腹部CTでS状結腸に不整な壁肥厚を認め,それより口側腸管に著明な拡張を認めた。S状結腸癌による大腸イレウスの疑いで,下部消化管内視鏡下に経肛門的イレウス管を留置し入院となった。翌日の血液検査でCRP 46.13 mg/dLと著明な上昇を認め,造影CTで左側小腸,下行結腸の腸管壁に造影効果の減弱を認め,腸管虚血が疑われため緊急手術を行った。回腸(Treitz靱帯より130 cm)から下行結腸に非連続性の腸管の壊死所見を認め,回腸からS状結腸までの腸管切除,人工肛門・粘液瘻造設術を施行した。術後5日目より食事開始,短腸症候群の可能性を考慮し静脈栄養を長期に併用しつつ栄養管理を行った。術後57日目に人工肛門を閉鎖し,明らかな栄養吸収障害はなく術後88日目で静脈栄養を終了し,経口摂取のみとして術後94日目に退院となった。大腸癌イレウスによる非閉塞性腸管虚血(NOMI)を発症した1例を経験したので報告する。