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術前診断に難渋した小腸出血に対して,術中ダブルバルーン小腸内視鏡を併用し,単孔式腹腔鏡下手術で治療しえた1例

患者は22歳,男性.Crohn病に対して内服加療中であった.下血を主訴に受診し,Hb5.8と貧血を認めた.CT検査や内視鏡検査では,出血源を認めなかった.小腸出血疑いでダブルバルーン小腸内視鏡(DBE)を行ったが,回腸の輪状狭窄のため肛門からの観察は不可能であった.以上,既往歴からCrohn病に伴う小腸出血の疑いと診断とした.繰り返す下血のため,手術の方針となった.
単孔式腹腔鏡下手術で開始した.右下腹部に腹壁と癒着したMeckel憩室を認め,憩室の口側腸管は高度に屈曲していた.Crohn病に伴う小腸出血を否定出来ず,術中DBEで全小腸を観察した.その際に臍部切開創から小腸を体外に出し,... Full description

Journal Title: 日本外科系連合学会誌 2018, Vol.43(1), pp.56-61
Main Author: 浦川, 真哉
Other Authors: 鄭, 充善 , 赤松, 大樹 , Urakawa, Shinya , Tei, Mitsuyoshi , Akamatsu, Hiroki
Format: Electronic Article Electronic Article
Language: jpn
Subjects:
ID: ISSN: 0385-7883 ; DOI: 10.4030/jjcs.43.56
Link: https://jlc.jst.go.jp/DN/JLC/20073948153?from=PrimoCentral
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recordid: jstageDN/JLC/20073948153
title: 術前診断に難渋した小腸出血に対して,術中ダブルバルーン小腸内視鏡を併用し,単孔式腹腔鏡下手術で治療しえた1例
format: Article
creator:
  • 浦川, 真哉
  • 鄭, 充善
  • 赤松, 大樹
  • Urakawa, Shinya
  • Tei, Mitsuyoshi
  • Akamatsu, Hiroki
subjects:
  • 小腸出血
  • 術中小腸内視鏡
  • 単孔式
  • Small Intestinal Bleeding
  • Intra-Operative Dbe
  • Single Incision Laparoscopic Surgery
ispartof: 日本外科系連合学会誌, 2018, Vol.43(1), pp.56-61
description: 患者は22歳,男性.Crohn病に対して内服加療中であった.下血を主訴に受診し,Hb5.8と貧血を認めた.CT検査や内視鏡検査では,出血源を認めなかった.小腸出血疑いでダブルバルーン小腸内視鏡(DBE)を行ったが,回腸の輪状狭窄のため肛門からの観察は不可能であった.以上,既往歴からCrohn病に伴う小腸出血の疑いと診断とした.繰り返す下血のため,手術の方針となった.
単孔式腹腔鏡下手術で開始した.右下腹部に腹壁と癒着したMeckel憩室を認め,憩室の口側腸管は高度に屈曲していた.Crohn病に伴う小腸出血を否定出来ず,術中DBEで全小腸を観察した.その際に臍部切開創から小腸を体外に出し,DBEを術者が用手的に誘導することで観察時間の短縮を図った.Meckel憩室以外の出血源を認めず,憩室を含む小腸切除を行った.
術中経口DBE併用は,出血部位の診断と必要最小限の小腸切除を可能とした.また単孔式腹腔鏡下手術は最小限の創部での治療を可能とし,低侵襲手術につながると考えられた.
language: jpn
source:
identifier: ISSN: 0385-7883 ; DOI: 10.4030/jjcs.43.56
fulltext: fulltext
issn:
  • 0385-7883
  • 03857883
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title術前診断に難渋した小腸出血に対して,術中ダブルバルーン小腸内視鏡を併用し,単孔式腹腔鏡下手術で治療しえた1例
creator浦川, 真哉 ; 鄭, 充善 ; 赤松, 大樹 ; Urakawa, Shinya ; Tei, Mitsuyoshi ; Akamatsu, Hiroki
ispartof日本外科系連合学会誌, 2018, Vol.43(1), pp.56-61
identifierISSN: 0385-7883 ; DOI: 10.4030/jjcs.43.56
subject小腸出血 ; 術中小腸内視鏡 ; 単孔式 ; Small Intestinal Bleeding ; Intra-Operative Dbe ; Single Incision Laparoscopic Surgery
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A 22-year-old man during medication therapy for Crohn disease presented at our hospital with melena and anemia. The cause of melena and anemia was not able to be identified with computed tomography, upper gastrointestinal endoscopy and total colonoscopy. The entire small intestine was also difficult to observe by double-balloon enteroscopy (DBE) because of the stenosis at the ileum. The patient underwent single incision laparoscopic surgery (SILS) for a diagnosis of small intestinal bleeding. The operation revealed that Meckelʼs diverticulum adheres to the abdominal wall. Other lesions ware detected by DBE. Pathological findings showed that Meckelʼs diverticulum causes small intestinal bleeding.

We consider that the combination of intra-operative DBE and SILS for small intestinal bleeding is useful and less invasive surgery.

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title術前診断に難渋した小腸出血に対して,術中ダブルバルーン小腸内視鏡を併用し,単孔式腹腔鏡下手術で治療しえた1例
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A 22-year-old man during medication therapy for Crohn disease presented at our hospital with melena and anemia. The cause of melena and anemia was not able to be identified with computed tomography, upper gastrointestinal endoscopy and total colonoscopy. The entire small intestine was also difficult to observe by double-balloon enteroscopy (DBE) because of the stenosis at the ileum. The patient underwent single incision laparoscopic surgery (SILS) for a diagnosis of small intestinal bleeding. The operation revealed that Meckelʼs diverticulum adheres to the abdominal wall. Other lesions ware detected by DBE. Pathological findings showed that Meckelʼs diverticulum causes small intestinal bleeding.

We consider that the combination of intra-operative DBE and SILS for small intestinal bleeding is useful and less invasive surgery.

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atitle術前診断に難渋した小腸出血に対して,術中ダブルバルーン小腸内視鏡を併用し,単孔式腹腔鏡下手術で治療しえた1例
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A 22-year-old man during medication therapy for Crohn disease presented at our hospital with melena and anemia. The cause of melena and anemia was not able to be identified with computed tomography, upper gastrointestinal endoscopy and total colonoscopy. The entire small intestine was also difficult to observe by double-balloon enteroscopy (DBE) because of the stenosis at the ileum. The patient underwent single incision laparoscopic surgery (SILS) for a diagnosis of small intestinal bleeding. The operation revealed that Meckelʼs diverticulum adheres to the abdominal wall. Other lesions ware detected by DBE. Pathological findings showed that Meckelʼs diverticulum causes small intestinal bleeding.

We consider that the combination of intra-operative DBE and SILS for small intestinal bleeding is useful and less invasive surgery.

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