多発外傷に対する集中治療後に発生した良性腸管気腫症：自験３例の臨床的特徴
腸管気腫症の病的意義は明らかではないが，腸管虚血や腸管壊死などの致死的な腹腔内病態を考慮することが必要である．今回，多発外傷に対する集中治療後に腸管気腫症を認め，保存的に軽快した良性腸管気腫症３例を経験したので，臨床的特徴を報告する．３例のいずれも高齢者多発外傷の集中治療後に生じ，発症時における低血圧や昇圧薬の使用はなく，明らかな腹部症状や腹膜炎所見，全身性炎症反応を認めていない．また，全例に先行する下痢を認め，腸管気腫はいずれも大腸に限局し，腹水や門脈ガス血症を伴わず，保存的治療にて改善した．本病態は，多発外傷に対する集中治療後に発生する良性腸管気腫症として捉えることができるものと考えられる...
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| Published in | Journal of the Japanese Association for the Surgery of Trauma Vol. 30; no. 3; pp. 316 - 320 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本外傷学会
2016
The Japanese Association for the Surgery of Trauma |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-6264 2188-0190 |
| DOI | 10.11382/jjast.30.316 |
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| Abstract | 腸管気腫症の病的意義は明らかではないが，腸管虚血や腸管壊死などの致死的な腹腔内病態を考慮することが必要である．今回，多発外傷に対する集中治療後に腸管気腫症を認め，保存的に軽快した良性腸管気腫症３例を経験したので，臨床的特徴を報告する．３例のいずれも高齢者多発外傷の集中治療後に生じ，発症時における低血圧や昇圧薬の使用はなく，明らかな腹部症状や腹膜炎所見，全身性炎症反応を認めていない．また，全例に先行する下痢を認め，腸管気腫はいずれも大腸に限局し，腹水や門脈ガス血症を伴わず，保存的治療にて改善した．本病態は，多発外傷に対する集中治療後に発生する良性腸管気腫症として捉えることができるものと考えられる． |
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| AbstractList | 腸管気腫症の病的意義は明らかではないが，腸管虚血や腸管壊死などの致死的な腹腔内病態を考慮することが必要である．今回，多発外傷に対する集中治療後に腸管気腫症を認め，保存的に軽快した良性腸管気腫症３例を経験したので，臨床的特徴を報告する．３例のいずれも高齢者多発外傷の集中治療後に生じ，発症時における低血圧や昇圧薬の使用はなく，明らかな腹部症状や腹膜炎所見，全身性炎症反応を認めていない．また，全例に先行する下痢を認め，腸管気腫はいずれも大腸に限局し，腹水や門脈ガス血症を伴わず，保存的治療にて改善した．本病態は，多発外傷に対する集中治療後に発生する良性腸管気腫症として捉えることができるものと考えられる． Although the pathogenesis of pneumatosis intestinalis is poorly understood, and its clinical significance is also unclear, the presence of critical abdominal conditions ; i.e., bowel ischemia and necrosis, should be considered in patients that have suffered severe traumas that require critical care. We report the clinical features of 3 cases of benign pneumatosis intestinalis that were treated conservatively. All 3 patients were elderly and had been released from the intensive care unit after being treated for multiple traumas. At diagnosis, they were not hypotensive ; were not taking vasopressors ; and did not exhibit any abdominal symptoms, peritonitis, or systemic inflammatory responses. All 3 patients had preceding intractable diarrhea. The pneumatosis intestinalis was localized in the colon, and no ascites or hepatic portal gas was detected. The patients all improved under conservative treatment without specific interventions. These symptoms might represent a benign from of postintensive care pneumatosis intestinalis that arises after multiple traumas. 腸管気腫症の病的意義は明らかではないが，腸管虚血や腸管壊死などの致死的な腹腔内病態を考慮することが必要である．今回，多発外傷に対する集中治療後に腸管気腫症を認め，保存的に軽快した良性腸管気腫症３例を経験したので，臨床的特徴を報告する．３例のいずれも高齢者多発外傷の集中治療後に生じ，発症時における低血圧や昇圧薬の使用はなく，明らかな腹部症状や腹膜炎所見，全身性炎症反応を認めていない．また，全例に先行する下痢を認め，腸管気腫はいずれも大腸に限局し，腹水や門脈ガス血症を伴わず，保存的治療にて改善した．本病態は，多発外傷に対する集中治療後に発生する良性腸管気腫症として捉えることができるものと考えられる． |
| Author | 大邉, 寛幸 久志本, 成樹 佐藤, 武揚 |
| Author_FL | KUSHIMOTO Shigeki OHBE Hiroyuki SATO Takeaki |
| Author_FL_xml | – sequence: 1 fullname: OHBE Hiroyuki – sequence: 2 fullname: SATO Takeaki – sequence: 3 fullname: KUSHIMOTO Shigeki |
| Author_xml | – sequence: 1 fullname: 大邉, 寛幸 organization: 東北大学病院救急科・高度救命救急センター – sequence: 1 fullname: 佐藤, 武揚 organization: 東北大学病院救急科・高度救命救急センター – sequence: 1 fullname: 久志本, 成樹 organization: 東北大学大学院医学系研究科外科病態学講座救急医学分野 |
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| Copyright | 2016 一般社団法人 日本外傷学会 |
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| DocumentTitleAlternate | CLINICAL CHARACTERISTICS OF BENIGN PNEUMATOSIS INTESTINALIS AFTER INTENSIVE CARE TREATMENT FOR SEVERE TRAUMA : A REPORT OF THREE CASES |
| DocumentTitle_FL | CLINICAL CHARACTERISTICS OF BENIGN PNEUMATOSIS INTESTINALIS AFTER INTENSIVE CARE TREATMENT FOR SEVERE TRAUMA : A REPORT OF THREE CASES |
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| References | 1) DuBose JJ, Lissauer M, Maung AA, et al : Pneumatosis Intestinalis Predictive Evaluation Study (PIPES) : a multicenter epidemiologic study of the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2013 ; 75 : 15-23. 2) Wu LL, Yang YS, Dou Y, et al : A systematic analysis of pneumatosis cystoids intestinalis. World J Gastroenterol 2013 ; 19 : 4973-4978. 3) Duron VP, Rutigliano S, Machan JT, et al : Computed tomographic diagnosis of pneumatosis intestinalis : clinical measures predictive of the need for surgical intervention. Arch Surg 2011 ; 146 : 506-510. 8) Lamont T, Rutgeerts P : Pneumatosis intestinalis. In : UpToDate, Post TW (Ed), UpToDate, Waltham, MA (accessed on Sep 2015). 5) Liao YT, Lin TH, Ko WJ : The early presence of pneumatosis in traumatic colonic perforation : a sequential computed tomography demonstration. Am J Emerg Med 2010 ; 28 : 645. e1-4. 4) Lee KS, Hwang S, Hurtado Rúa SM, et al : Distinguishing benign and life-threatening pneumatosis intestinalis in patients with cancer by CT imaging features. Am J Roentgenol 2013 ; 200 : 1042-1047. 7) Koutouzis T, Lee J : Blunt abdominal trauma resulting in Pneumatosis intestinalis in an infant. Ann Emerg Med 2000 ; 36 : 619-621. 6) Grimm JC, Berger JC, Lipsett PA, et al : A case of profound pneumatosis intestinalis in a patient with recent polytrauma. J Trauma Acute Care Surg 2015 ; 78 : 209-210. |
| References_xml | – reference: 1) DuBose JJ, Lissauer M, Maung AA, et al : Pneumatosis Intestinalis Predictive Evaluation Study (PIPES) : a multicenter epidemiologic study of the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2013 ; 75 : 15-23. – reference: 7) Koutouzis T, Lee J : Blunt abdominal trauma resulting in Pneumatosis intestinalis in an infant. Ann Emerg Med 2000 ; 36 : 619-621. – reference: 6) Grimm JC, Berger JC, Lipsett PA, et al : A case of profound pneumatosis intestinalis in a patient with recent polytrauma. J Trauma Acute Care Surg 2015 ; 78 : 209-210. – reference: 4) Lee KS, Hwang S, Hurtado Rúa SM, et al : Distinguishing benign and life-threatening pneumatosis intestinalis in patients with cancer by CT imaging features. Am J Roentgenol 2013 ; 200 : 1042-1047. – reference: 8) Lamont T, Rutgeerts P : Pneumatosis intestinalis. In : UpToDate, Post TW (Ed), UpToDate, Waltham, MA (accessed on Sep 2015). – reference: 2) Wu LL, Yang YS, Dou Y, et al : A systematic analysis of pneumatosis cystoids intestinalis. World J Gastroenterol 2013 ; 19 : 4973-4978. – reference: 3) Duron VP, Rutigliano S, Machan JT, et al : Computed tomographic diagnosis of pneumatosis intestinalis : clinical measures predictive of the need for surgical intervention. Arch Surg 2011 ; 146 : 506-510. – reference: 5) Liao YT, Lin TH, Ko WJ : The early presence of pneumatosis in traumatic colonic perforation : a sequential computed tomography demonstration. Am J Emerg Med 2010 ; 28 : 645. e1-4. |
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| SubjectTerms | intensive care pneumatosis intestinalis trauma 外傷 腸管気腫症 集中治療 |
| Title | 多発外傷に対する集中治療後に発生した良性腸管気腫症：自験３例の臨床的特徴 |
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