その他(Miscellaneous)シリーズ3 RESIDENT COURSE 解答 【症例 MR 15】

胃瘻チューブによる腸重積.Intussusception by a gastrostomy tube








図2〜図5で胃と十二指腸(丸数字12)がやや拡張している.図3〜図10の空腸病変:△は腸重積である.図3の↑が嵌入部で,図6と図7で胃瘻チューブを含む虚脱した内筒(A)があり,その周囲に血管を含む脂肪組織(B),すなわち腸間膜が腸管内に存在することが重積の診断根拠である.図12〜図15の▲が重積の原因となった,胃瘻チューブ先端の,生食水で膨らませたバルーンである.バルーンの生食水を抜き,胃まで抜去し固定し直して治癒した.








文献考察:胃瘻チューブによる腸重積
Kurume Med J. 2001;48(3):237-40.
Intussusception during enteral nutrition: a case report.
Noake T, Yoshida S, Fujita H, Ishibashi N, Shirouzu K.

We report a case of intussusception during enteral nutrition after esophagectomy. The case was a 60-year-old patient who underwent subtotal esophagectomy via the right thoraco-abdominal approach, reconstructed with esophagogastrostomy. He underwent tube feeding through gastrostomy after surgery. The tip of the feeding tube was emplaced in the jejunum. He complained of intermittent abdominal pain and the drainage volume through the gastric decompression tube was increased on the 2nd week from surgery. There was no abnormal finding on abdominal CT or or radiography of the digestive tract, and so a diagnosis of intussusception was made and laparotomy was performed. There was descending intussusception with the jejunum where the feeding tube was emplaced. Enterectomy was not necessary in this case. Adult intussusception is rare. The surgery is sometimes the cause for intussusception. Another cause is use of a long intestinal tube. Since enteral nutrition has priority for nutritional support after esophagectomy, it is important to make an early decision whether surgical intervention is required or not, using abdominal examination by CT, ultrasound and contrast radiography, when bowel obstruction occurs during enteral nutrition through a feeding tube.   PMID: 11680941

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