Noake T, Yoshida S, Fujita H, Ishibashi N, Shirouzu K
Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
Kurume Med J. 2001;48(3):237-40. doi: 10.2739/kurumemedj.48.237.
We report a case of intussusception during enteral nutrition after esophagectomy. The case was a 60-year-old patient who underwent subtotal esophagectomy via the right thoraco-abdominal approach, reconstructed with esophagogastrostomy. He underwent tube feeding through gastrostomy after surgery. The tip of the feeding tube was emplaced in the jejunum. He complained of intermittent abdominal pain and the drainage volume through the gastric decompression tube was increased on the 2nd week from surgery. There was no abnormal finding on abdominal CT or or radiography of the digestive tract, and so a diagnosis of intussusception was made and laparotomy was performed. There was descending intussusception with the jejunum where the feeding tube was emplaced. Enterectomy was not necessary in this case. Adult intussusception is rare. The surgery is sometimes the cause for intussusception. Another cause is use of a long intestinal tube. Since enteral nutrition has priority for nutritional support after esophagectomy, it is important to make an early decision whether surgical intervention is required or not, using abdominal examination by CT, ultrasound and contrast radiography, when bowel obstruction occurs during enteral nutrition through a feeding tube.
我们报告了一例食管癌切除术后肠内营养期间发生肠套叠的病例。该病例为一名60岁患者，经右胸腹联合入路行食管次全切除术，采用食管胃吻合术重建。术后通过胃造口进行管饲。饲管尖端置于空肠。术后第2周，患者主诉间歇性腹痛，胃减压管引流量增加。腹部CT或消化道造影未发现异常，因此诊断为肠套叠并进行了剖腹手术。在放置饲管的空肠处发生了下行性肠套叠。该病例无需进行肠切除术。成人肠套叠罕见。手术有时是肠套叠的原因。另一个原因是使用长肠管。由于食管癌切除术后肠内营养是营养支持的优先选择，因此在通过饲管进行肠内营养期间发生肠梗阻时，利用CT、超声和造影检查进行腹部检查，尽早决定是否需要手术干预非常重要。
