急性逆行性空腸胃重積症の一例

内視鏡診断の意義と文献的考察

抄録

Retrograde jejunogastric intussusception is a rare condition in Japan. This report deals with a case of acute retrograde jeunogastric intussusception preo-peratively confirmed by gastrofiberscopy. The relevant literature has been reviewed. Case A 60-year-old Japanese male in fair general condition was admitted to the medical ward of the Kawasaki Medical College Hospital with complaints of sudden onset of moderate epigastric pain, vomiting of coffee -grounds material. 11 years ago, the patient was diagnosed “Duodenal ulcer”, and gastric resection (Billroth II) was per-formed. After operation, there was no significant symptom in upper G-I tract. Physical examination revealed left upper abdominal tenderness without palpable mass. An upper gastroint-estinal X-ray series showed a semicircular filling defect within a distended remnant stomach. Across the defect, there were parallel lines, simulating “coiled spring” (Fig. 1). A gastrof iberscopic examination revealed a marked invagination of the jejunum through the stoma, forming mountain range like tumors with dark violet-brown colored banana-like appearance. Coffee grounds liquid was noted, in the remnant stomach (Fig. 2, 3, 4, ). A diagnosis of acute retrograde jejunogastric intussusception was made. An emergency eperation was perf omed. The efferent loop of jejunum was inv aginated through the gastro-enterostomy into the gastric remnant. The jejunogastric intussusception was successfully treated by excision of the intussuscept of jejunum. The postoperative course was uneventful, and since discharge no further abdominal complaints have been registered.