外傷性メッケル憩室穿孔の1例
メッケル憩室は消化管の先天的奇形のひとつで多くは無症状だが, まれに出血や炎症が生じる. 我々は外傷性メッケル憩室穿孔というまれな症例を経験した. 症例は52歳男性, バイク乗車中に受傷し, 左下肢・下腹部に強い自発痛を認めた. バイタルサインは安定, 体表所見は右前胸部, 左側腹部, 手指に打撲痕と挫傷, 左大腿部腫脹を認めた. 造影CT上, 軽微なfree airと腹水を認めた. 経時的に腹水が増加したため同日緊急開腹術を行った. 開腹時, 血性腹水と腸液を確認した. 回盲部から40cmにメッケル憩室の穿孔を認め, 楔状に切離修復した. 他に腸間膜の損傷を数ヵ所認め止血修復し, 術後経過は...
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| Published in | 日本外傷学会雑誌 Vol. 34; no. 3; pp. 40 - 43 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本外傷学会
20.07.2020
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-6264 2188-0190 |
| DOI | 10.11382/jjast.34.3_01 |
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| Abstract | メッケル憩室は消化管の先天的奇形のひとつで多くは無症状だが, まれに出血や炎症が生じる. 我々は外傷性メッケル憩室穿孔というまれな症例を経験した. 症例は52歳男性, バイク乗車中に受傷し, 左下肢・下腹部に強い自発痛を認めた. バイタルサインは安定, 体表所見は右前胸部, 左側腹部, 手指に打撲痕と挫傷, 左大腿部腫脹を認めた. 造影CT上, 軽微なfree airと腹水を認めた. 経時的に腹水が増加したため同日緊急開腹術を行った. 開腹時, 血性腹水と腸液を確認した. 回盲部から40cmにメッケル憩室の穿孔を認め, 楔状に切離修復した. 他に腸間膜の損傷を数ヵ所認め止血修復し, 術後経過は良好であった. なお, 切除検体の病理検査では異所性粘膜は認めなかった. |
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| AbstractList | メッケル憩室は消化管の先天的奇形のひとつで多くは無症状だが, まれに出血や炎症が生じる. 我々は外傷性メッケル憩室穿孔というまれな症例を経験した. 症例は52歳男性, バイク乗車中に受傷し, 左下肢・下腹部に強い自発痛を認めた. バイタルサインは安定, 体表所見は右前胸部, 左側腹部, 手指に打撲痕と挫傷, 左大腿部腫脹を認めた. 造影CT上, 軽微なfree airと腹水を認めた. 経時的に腹水が増加したため同日緊急開腹術を行った. 開腹時, 血性腹水と腸液を確認した. 回盲部から40cmにメッケル憩室の穿孔を認め, 楔状に切離修復した. 他に腸間膜の損傷を数ヵ所認め止血修復し, 術後経過は良好であった. なお, 切除検体の病理検査では異所性粘膜は認めなかった. |
| Author | 長谷川, 綾香 岡田, 保誠 小島, 直樹 有野, 聡 佐々木, 庸郎 一瀬, 麻紀 高木, 淑恵 山口, 和将 松田, 隼 稲川, 博司 |
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| References | 1) Zami A, Eaton S, Rec CM, et al : Incidentally Detected Meckel Diverticulum, to resect or not to resect?. Ann Surg 2008 ; 247 : 276-281. 5) Park H, Lucas CE : PERFORATED MECHEL’S DIVERTICULUM FOLLOWING BLUNT ABDOMINAL TRAUMA. J Trauma 1970 ; 10 : 706-707. 9) Ekwunife CN, Mbadugha TN, Ogbue UN : Isolated Meckel’s diverticulum perforation as a sequel to blunt abdominal trauma_ a case report. J Med Case Rep 2014 ; 8 : 111. 13) Ding Y, Zhou Y, Ji Z, et al : Laparoscopic Management of Perforated Meckel’s Diverticulum in Adults. Int J Med Sci 2012 ; 9 : 243-245. 6) Sartorelli KH, Haeley C, Deross A : Perforated Meckel’s Diverticulum in a Child After Blunt Abdominal Trauma. J Trauma 2007 ; 63 : 1167-1168. 8) Kazemi K, Jalaeian H, Fattahi MR, et al : Ruptured Meckel’s Mesodiverticulum and Meckel’s Diverticulum following Blunt Abdominal Trauma. Med Princ Pract 2008 ; 17 : 161-163. 3) Yamaguchi M, Takeuchi S, Awazu S : Meckel’s Diverticulum investigation of 600 patients in Japanese Literature. Am J Surg 1978 ; 146 : 247-249. 7) 松木盛行, 水本晋作, 朝来野弦, ほか : 外傷性メッケル憩室穿孔の1例. 日救急医会関東誌 1988 ; 9 : 590-591. 12) Bensard DD, Beaver BL, Besner GE, et al : Small Bowel Injury in Children after Blunt Abdominal Trauma : Is Diagnostic Delay Important?. J Trauma 1996 ; 41 : 476-483. 4) Turgeon DK, Barnett JL : Meckel’s Diverticulum. Am J Gastroenterol 1990 ; 85 : 777-781. 11) Canty Sr TG, Cantry Jr TG, Brown C : Injuries of the Gastrointestinal Tract from Blunt Trauma in Children : A 12-Year Experience at a Designated Pediatric Trauma Center. J Trauma 1999 ; 46 : 234-240. 2) Perne AS : Meckel’s diverticulum. N Eng J Med 1959 ; 260 : 690. 10) Rutledge R, Thomason M, Oller D, et al : The Spectrum of Abdominal Injuries Associated with The Use of Seat Belts. J Trauma 1991 ; 31 : 820-826. |
| References_xml | – reference: 7) 松木盛行, 水本晋作, 朝来野弦, ほか : 外傷性メッケル憩室穿孔の1例. 日救急医会関東誌 1988 ; 9 : 590-591. – reference: 5) Park H, Lucas CE : PERFORATED MECHEL’S DIVERTICULUM FOLLOWING BLUNT ABDOMINAL TRAUMA. J Trauma 1970 ; 10 : 706-707. – reference: 3) Yamaguchi M, Takeuchi S, Awazu S : Meckel’s Diverticulum investigation of 600 patients in Japanese Literature. Am J Surg 1978 ; 146 : 247-249. – reference: 12) Bensard DD, Beaver BL, Besner GE, et al : Small Bowel Injury in Children after Blunt Abdominal Trauma : Is Diagnostic Delay Important?. J Trauma 1996 ; 41 : 476-483. – reference: 6) Sartorelli KH, Haeley C, Deross A : Perforated Meckel’s Diverticulum in a Child After Blunt Abdominal Trauma. J Trauma 2007 ; 63 : 1167-1168. – reference: 1) Zami A, Eaton S, Rec CM, et al : Incidentally Detected Meckel Diverticulum, to resect or not to resect?. Ann Surg 2008 ; 247 : 276-281. – reference: 10) Rutledge R, Thomason M, Oller D, et al : The Spectrum of Abdominal Injuries Associated with The Use of Seat Belts. J Trauma 1991 ; 31 : 820-826. – reference: 11) Canty Sr TG, Cantry Jr TG, Brown C : Injuries of the Gastrointestinal Tract from Blunt Trauma in Children : A 12-Year Experience at a Designated Pediatric Trauma Center. J Trauma 1999 ; 46 : 234-240. – reference: 4) Turgeon DK, Barnett JL : Meckel’s Diverticulum. Am J Gastroenterol 1990 ; 85 : 777-781. – reference: 9) Ekwunife CN, Mbadugha TN, Ogbue UN : Isolated Meckel’s diverticulum perforation as a sequel to blunt abdominal trauma_ a case report. J Med Case Rep 2014 ; 8 : 111. – reference: 13) Ding Y, Zhou Y, Ji Z, et al : Laparoscopic Management of Perforated Meckel’s Diverticulum in Adults. Int J Med Sci 2012 ; 9 : 243-245. – reference: 8) Kazemi K, Jalaeian H, Fattahi MR, et al : Ruptured Meckel’s Mesodiverticulum and Meckel’s Diverticulum following Blunt Abdominal Trauma. Med Princ Pract 2008 ; 17 : 161-163. – reference: 2) Perne AS : Meckel’s diverticulum. N Eng J Med 1959 ; 260 : 690. |
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| Title | 外傷性メッケル憩室穿孔の1例 |
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