臨牀消化器内科 Vol.19 No.9(5)


特集名 イレウス診療のpitfall -- いつ外科に送るか
題名 絞扼性イレウスの診断
発刊年月 2004年 08月
著者 高崎 秀明 日本医科大学第一外科
著者 田尻 孝 日本医科大学第一外科
著者 鶴田 宏之 日本医科大学第一外科
【 要旨 】 絞扼性イレウスを疑う所見を，症例を提示しながら解説した．急激に発症するイレウスでショックとなった場合は典型的な絞扼性イレウスで，内科医も迷うことなく外科に送ることであろう．問題は癒着性イレウスと鑑別が困難な症例で，(1) 鎮痛剤を頻回に使用しても疼痛が改善しない場合，(2) CTスキャン，超音波検査にて腹水の貯留，増加を認めた場合，(3) CTスキャンで腸間膜の異常伸展，渦巻状変化，(4) 造影CTスキャンでenhanceされない腸管壁の存在が確認できた場合，(5) long tubeを挿入し，イレウスが解除しないのに排液量が少ない場合，あるいはlong tubeが先進しない場合などは絞扼性イレウスである可能性が高いので，至急外科に相談すべきである．
Theme Diagnosis and Treatment of Intestinal Obstruction: Timing in Consulting a Surgeon
Title Diagnosis of Strangulated Small Bowel Obstruction
Author Hideaki Takasaki Department of Surgery 1, Nippon Medical School
Author Takashi Tajiri Department of Surgery 1, Nippon Medical School
Author Hiroyuki Tsuruta Department of Surgery 1, Nippon Medical School
[ Summary ] We demonstrated four cases of strangulated small bowel obstruction (SBO), and mentioned important points concerning differential diagnoses between adhesive SBO and strangulated SBO.
In strangulated SBO, there are two types of clinical symptoms, one with typical severe abdominal pain and shock, the other with milder symptoms which is difficult to differentially diagnose as adhesive SBO. The later cases tend to be treated conservatively at first.
To know when to consult surgeons, physician should pay attention to the following signs;
(1) Severe abdominal pain ineffective treated with anodyne.
(2) Massive ascites seen in CT scans or ultrasonography.
(3) Mesenterial abnormalities, such as excessive extension or mesenteric whirl formations.
(4) The presence of non-enhanced bowel walls, seen in enhanced CT scans.
(5) In conservative therapy, the amount of discharge from decompression tubes provides valuable information. Without resolution of SBO, a decrease in the amount of discharge suggests the presence of a closed loop.
These signs strongly suggest the presence of strangulated SBO.
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