论文信息 - A Case of Chronic Idiopathic Colonic Pseudoobstruction Whose Life was Saved by Emergency Subtotal Colectomy

A Case of Chronic Idiopathic Colonic Pseudoobstruction Whose Life was Saved by Emergency Subtotal Colectomy

呼吸困難が出現し緊急手術にて救命しえた慢性特発性大腸偽性腸閉塞症の1例を経験したので報告する. 症例は60歳男性. 以前より便秘にて近医通院中であった. 腸閉塞症状が出現し近医入院, 保存的加療を行うも増悪するため当院緊急入院となった. 腹部は著明に膨満し, 腸雑音は消失していた. 徐々に内視鏡的ガス抜きを施行するも腹部膨満の増悪と呼吸障害が出現, 全身状態が悪化, 緊急手術を施行した. 大腸は盲腸から直腸まで著明に拡張し, とくにS状結腸に顕著であった. 大腸亜全摘術, 回腸人工肛門造設術を施行した. 術翌日には呼吸状態, 循環動態ともに改善し, 術後1年以上経過した現在特記すべき障害は認めていない.本症は腸管に器質的閉塞・狭窄や原因となる基礎疾患がないにもかかわらず, 大腸のみに腸閉塞様の症状を繰り返す疾患であるが, 保存的加療抵抗性の場合には外科的切除術も治療の選択肢の一つにあげるべきであると考えられた.

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