2708 日本臨床外科学会雑誌 Table 1 Laboratory data 66巻 on admission Fig. 2: Gastrointestinal the left hollow hollow was endoscopy the was the afferent was

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2708 日本臨床外科学会雑誌 Table 1 Laboratory data 66巻 on admission Fig. 2: Gastrointestinal the left hollow hollow was endoscopy the was the afferent was the transverse Fig.

2 2708 日本臨床外科学会雑誌 Table 1 Laboratory data 66巻 on admission Fig. 2: Gastrointestinal the left hollow hollow was endoscopy the was the afferent was the transverse Fig. 3: Abdominal demonstrated efferent loop loop, that the middle and the right hollow colon. enhanced 3D-Computer Tomogra phy demonstrated that the upper hollow was the efferent loop, the right hollow was the afferent loop and the left hollow Mg. 1: The barium enema study demonstrated the fistula from the transverse colon to the jejunum, the remnant stomach and the esophagus. was the transverse 難だったため胃空腺Roux-enY吻 colon. 合を結腸後で行った.なお,横行結腸の瘻孔部は単純縫合閉鎖した(Fig. 4). 以上の検査結果から,初回の術式は幽門側胃切除術, 術後経過は良好で下痢の消失とともに消化吸収機能 BillrothII法再建,結腸前胃空腸吻合術であり,吻合部が改善し術後3カ潰瘍による空腸横行結腸瘻と術前診断した. 2カ月目に経過観察目的で上部消化管内視鏡検査を行ったところ,吻手術所見: 2003年11月下旬開腹手術を施行した.瘻 2カ所認めた.まが21cmと 116mEq/1とと過長であった.残胃は左胃動脈ならびに左胃大網動 (Rabeprazole Stageの再発病変をた同時に測定した空腹時胃酸濃度は高酸度であつた.再 20mg/日)投脈の最終前枝を結ぶ線の口側で切離し,胃空腸吻合部 S1Stageとを切除した.再建は十二指腸断端が癒着高度で剥離困維持療法中である. 82 体重増加を認めた.術後合部空腸側にH1 孔部は吻合部空腸後壁よりに存在した.残胃は大轡側大きく,また輸入脚もTreitz靱帯から36cm 月で6kgの発病変はPPI内服与後の上部内視鏡検査で改善を認め,現在もRabeprazole 10mg/日

3 Fig. 4: Operation record: The gastrojejunocolic fistula was the poste rior wall of the jejunum side of the anastomosis. The greater curvature was 21cm. The afferent loop was 36cm from the Treitz ligament. The reconstruction was Roux-en Y method.

5 A CASE OF GASTROJEJUNOCOLIC FISTULA DUE TO STOMAL ULCER Naoto NISHIGORI, Yukio AOMATSU, Heisuke FUJIMOTO, Takashi INOUE, Hirofumi KUWATA and Yoshiyuki NAKAJIMA* Department of Surgery, Matsubara Municipal Hospital *Department of Surgery, Nara Medical University A 62-year-old man, who had undergone distal gastrectomy with Billroth II reconstruction for perforated duodenal ulcer at the age of 40, suddenly developed severe abdominal pain in October 2002, and there after he suffered from diarrhea and body weight loss. Barium enema study, gastrointestinal endoscopy and abdominal CT scan revealed a gastrojejunocolic fistula due to the stomal ulcer. We performed partial resection of the stomach and jejunum, closure of the fistula of the transverse colon, and reconstruction with Roux-en Y method in November The absorption function was restared and the patient gained 6kg of weight three months after the surgery. Gastrointestinal endoscopy revealed recurrence of the stomal ulcer two months after the surgery when the gastric acid level on a fasting stomach was high, 116mEq/l. Oral administration of a proton pump inhibitor (PPI) improved the recurrent ulcer and then PPI at a maintenance low dose controlled the progress of the disease. Stomal ulcer has an etiological background of hypersecresion of gastric acid, so that it is prone to recur repeatedly after surgery. We must employ operative procedures that assure no more recurrence.

39_6_28_DrTakanashi.indd

39_6_28_DrTakanashi.indd 日外科系連会誌 39(6):1105 1109,2014 症例報告胃切除 B-Ⅱ 再建後の胃空腸横行結腸瘻の 1 例富士宮市立病院外科高梨裕典礒垣淳川辺昭浩内容要旨胃空腸横行結腸瘻は, 胃切除後の吻合部潰瘍によって引き起こされる比較的稀な合併症である. 症例は74 歳男性. 昭和 42 年, 十二指腸潰瘍に対し幽門側胃切除 BillrothⅡ 法再建術 ( 結腸後 ) を施行された. 平成 25

2708 日本 臨 床 外 科 学 会雑 誌 Table 1 Laboratory data 66巻 on admission Fig. 2: Gastrointestinal the left hollow hollow was endoscopy the was the afferent was

2708 日本臨床外科学会雑誌 Table 1 Laboratory data 66巻 on admission Fig. 2: Gastrointestinal the left hollow hollow was endoscopy the was the afferent was