Sakurai Yoichi, Kimura Harumi, Sunagawa Risaburo, Furuta Shinpei, Inaba Kazuki, Isogaki Jun, Komori Yoshiyuki, Uyama Ichiro
Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
Surg Laparosc Endosc Percutan Tech. 2008 Dec;18(6):604-7. doi: 10.1097/SLE.0b013e3181875509.
In patients with repeated intestinal obstructions after open abdominal surgery, aerophagia associated with disturbances in gastrointestinal passage causes the accumulation of large amounts of air, resulting in chronic symptoms including abdominal pain and distention and consequently malnutrition. We successfully used percutaneous endoscopic gastrostomy (PEG) for long-term gastric decompression in 2 cases with aerophagia. The first case was a 69-year-old Japanese man admitted for repeated intestinal obstruction after an appendectomy. After the last surgery for intestinal obstruction, the patient experienced repeated abdominal distention and anorexia, resulting in weight loss and malnutrition. The second case was a 79-year-old man complaining of abdominal pain and distention. He had a history of resection of the lower pharynx and larynx owing to total laryngectomy and had received a permanent tracheostomy. He then underwent surgery for intestinal obstruction. Because the patients' abdominal symptoms were unresponsive to administration of a peristalsis stimulant and a laxative, we performed PEG to deflate the gastrointestinal tract. An abdominal x-ray taken after the PEG placement showed the elimination of the gas and a remarkable improvement in the gastric dilatation, and the abdominal symptoms soon disappeared. These cases highlight the clinical importance and usefulness of PEG for gastric decompression in patients with aerophagia associated with repeated intestinal obstruction.
在接受开腹手术后反复发生肠梗阻的患者中，与胃肠道蠕动紊乱相关的吞气症会导致大量气体积聚，从而引发包括腹痛和腹胀在内的慢性症状，并进而导致营养不良。我们成功地对2例患有吞气症的患者采用经皮内镜下胃造口术（PEG）进行长期胃减压。第一例是一名69岁的日本男性，因阑尾切除术后反复发生肠梗阻入院。在最后一次肠梗阻手术后，患者反复出现腹胀和厌食，导致体重减轻和营养不良。第二例是一名79岁男性，主诉腹痛和腹胀。他因全喉切除术有下咽和喉部切除史，并接受了永久性气管造口术。随后他接受了肠梗阻手术。由于患者的腹部症状对给予促蠕动剂和泻药无反应，我们进行了PEG以排出胃肠道气体。PEG放置后拍摄的腹部X线片显示气体消失，胃扩张明显改善，腹部症状很快消失。这些病例突出了PEG在伴有反复肠梗阻的吞气症患者中进行胃减压的临床重要性和实用性。
