残胃全摘,Roux en Y法再建術後早期に発症した輸入脚閉塞症の1例

概要

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A 68-year-old man underwent total gastrectomy, end-to-side esophagojejunostomy, and Roux en Y (R-Y) anastomosis for adenocarcinoma of the remnant stomach. The patient had a history of subtotal gastrectomy with Billroth I anastomosis for gastric cancer 8 years prior to the present admission. Nine days later, he presented with abdominal pain. Abdominal ultrasonography and computed tomography showed dilated afferent loop and distended gallbladder. Twelve days after the operation he underwent laparotomy. The afferent loop obstruction due to severe adhesion of jejunum at R-Y anastomosis was disclosed. Lysis of adhesions and tube jejunostomy for drainage of afferent loop were performed. Symptoms from afferent loop obstruction decreased. After one month, he became to eat his fill by mouth. Post-gastrectomy obstruction of the afferent loop is a serious complication where sudden abdominal pain occurs once complete occlusion develops, and unless appropriate surgical treatments are taken early, the condition leads to dilatation, perforation, and necrosis of the afferent loop, with a fatal outcome. If abdominal pain occurs after gastrectomy, it is necessary to keep in mind the probable presence of this disease.
新潟大学の論文
2004-04-10