三木 康彰¹, 角村 純一¹, 水谷 伸¹, 吉岡 泰彦¹, 佐々木 隆士¹, 門田 治¹, 永井 勲¹, 田中 智之², 竹中 正人³, 中戸 洋行³, 山本 忠生⁴

Yasuaki MIKI¹, Jyunichi SUMIMURA¹, Shin MIZUTANI¹, Yasuhiko YOSHIOKA¹, Takasi SASAKI¹, Osamu MONTA¹, Isao NAGAI¹, Tomoyuki TANAKA², Masato TAKENAKA ³, Hiroyuki NAKATO³, Tadao YAMAMOTO⁴

¹社会保険紀南綜合病院外科, ²社会保険紀南綜合病院病理部, ³社会保険紀南綜合病院生理機能検査部, ⁴社会保険紀南綜合病院内科

¹Department of Surgery, Kinan General Hospital , ²Department of Pathology, Kinan General Hospital , ³Department of Physiological Examination, Kinan General Hospital , ⁴Department of Internal Medicine, Kinan General Hospital

キーワード : Complication of long intestinal tube, Ileus, Intussusception, Ultrasonography

A case of postlaparotomy jejunal intussusception that was apparently caused by a long initestinal tube (LT) is reported here. The patient, a 74-year-old man who had been admitted to this institution because of adhesive ileus after the LT was inserted, had a history of distal gastrectomy for early gastric cancer two years earlier. The adhesions was separated, and the ileum was partially resected, but the LT was left in the jejunum for postoperative bowel decompression. The LT was removed immediately on the third postoperative day, however, when intermittent vomiting and left upper abdominal pain occurred. Conservative treatment was performed, and the patient was kept under observation. Although fluid levels were not discernible in abdominal x-ray films, ultrasonography showed intussusception where the tip of the LT had been located. Intestinal peristalsis and Kerckring's folds had both disappeared, and the pseudo-kidney sign was detected on repeat ultrasonography. Also, the swollen, strangulated bowel wall was thickened and had low echogenicity accompanied by several high spots. These findings were considered to result from jejunal ischemia caused by intussusception, so laparotomy was performed on the fortieth postoperative day. An antegrade intussusception 15 cm long and located 20 cm from the origin of the jejunum was found on surgery. Because the intussusception was associated with ischemia and necrosis, the affected bowel was resected and end-to-end anastomosis was performed. The patient's postoperative progress was good. This intussusception was attributed to the LT that had entered the jejunum without deflation of the balloon and had been fixed at the patient's nose. Abdominal ultrasonography proved useful in making the diagnosis and in determining the treatment.