| 特集名 | 緊急内視鏡の適応と実際 | |
|---|---|---|
| 題名 | 消化管軸捻転 | |
| 発刊年月 | 2018年 05月 | |
| 著者 | 三上 達也 | 弘前大学医学部附属病院光学医療診療部 |
| 著者 | 相原 智之 | 弘前市立病院内科 |
| 著者 | 佐竹 美和 | 弘前市立病院内科／弘前大学大学院医学研究科消化器血液内科学講座 |
| 著者 | 坂本 十一 | 弘前市立病院内科 |
| 著者 | 東野 博 | 弘前市立病院内科 |
| 著者 | 福田 眞作 | 弘前大学医学部附属病院光学医療診療部／弘前大学大学院医学研究科消化器血液内科学講座 |
| 【 要旨 】 | 消化管軸捻転は大腸に発生することが多く，とくにS状結腸に多く発生する．腹部単純X線写真のcoffee bean signは有名であるが，CTで穿孔，腸管壊死の徴候がないことを確認する必要がある．徴候があれば手術を考慮する．内視鏡を挿入する際には，少量の送気で愛護的に捻転部を越え，拡張腸管部のガスを吸引し，脾彎曲部まで挿入して直線化する． 胃軸捻転はまれな疾患であり，その多くはCTで診断される．こちらも穿孔，胃壁壊死の徴候があれば手術を考慮する．まずは胃管を挿入して減圧を期待する．送気が過剰にならないように注意しながら内視鏡を肛門側に挿入し，十二指腸下行脚まで挿入して直線化する． いずれも整復後に繰り返す場合は待機的手術を考慮する． |
|
| Theme | Indications and Standards of Practice for Emergency Endoscopy | |
|---|---|---|
| Title | Volvulus of the Gastrointestinal Tract | |
| Author | Tatsuya Mikami | Division of Endoscopy, Hirosaki University Hospital |
| Author | Tomoyuki Aihara | Department of Internal Medicine, Hirosaki Municipal Hospital |
| Author | Miwa Satake | Department of Internal Medicine, Hirosaki Municipal Hospital / Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine |
| Author | Juichi Sakamoto | Department of Internal Medicine, Hirosaki Municipal Hospital |
| Author | Hiroshi Tono | Department of Internal Medicine, Hirosaki Municipal Hospital |
| Author | Shinsaku Fukuda | Division of Endoscopy, Hirosaki University Hospital / Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine |
| [ Summary ] | Volvulus of the gastrointestinal tract primarily affects the sigmoid colon and the coffee-bean sign noted on plain abdominal radiography is pathognomonic of this condition. Furthermore, it is necessary to perform abdominal CT to identify perforation and/or necrosis of the colonic wall. Emergency surgery is warranted if any such signs are identified. When performing colonic endoscopy, the instrument should be gently inserted through the anus, and the twisted narrow lumen should be observed in the sigmoid colon. After passing the scope across the twisted narrow lumen, air should be suctioned, and the scope should be advanced to the splenic flexure to correct the volvulus. Gastric volvulus is a rare disease entity, which is usually diagnosed on abdominal CT. Emergency surgery is required when a perforation and/or necrosis of the gastric wall has been identified. Initially, a nasogastric tube ought to be inserted to decompress the stomach. Next, an upper GI endoscopy is performed to evaluate the descending segment of the duodenum. Elective surgery should be considered in patients presenting with recurrent volvulus. |
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