高位空腸瘻及び非経腸栄養で小腸広範囲切除を回避しえた中腸軸捻転の1治験例

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A 3 day-old boy with bloody stool, abdominal distension and bilious vomiting was transferred to our hospital in a preshock condition. The diagnosis of malrotation with midgut volvulus was made by upper GI series. The patient underwent laparotomy immediately. The massive involvement of the small bowel from the proximal jejunum to the terminal ileum was found. The reduction of volvulus and Ladd's operation were performed. The second-look operation done 22 hours later showed no dramatic improvement in the ischemic bowel. High jejunostomy just oral to the proximal end of the lesion and peritoneal drainage were done without resection of the grossly ischemic bowel. There were no immediate postoperative problems. The third operation undertaken for a closure of jejunostomy one month after second-look operation revealed recovery of all the small bowel from a pregangrenous condition and the stricture of the jejunum anal to the distal stoma. The stricture and jejunostomy were taken down and able to be reconstructed by primary anastomosis, preserving one meter of small bowel. TPN was weaned within 2 months after closure of jejunostomy and the following course was satisfactory. He showed neither growth nor intellectual retardation at the time of follow-up of 2 years old. This new technique which had been used for massive necrotizing enterocolitis was applied successfully for a patient with midgut volvulus. It is suggested that this approach is a new surgical strategy of avoiding massive small bowel resection.
日本小児外科学会の論文
1989-06-20

高位空腸瘻及び非経腸栄養で小腸広範囲切除を回避しえた中腸軸捻転の1治験例

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