腹腔鏡下癒着剥離術後, 再度イレウスを発症し腸管切除術が必要となった 癒着性イレウスの一例

A 12-year old boy with a history of surgery for a gastroschisis in the neonatal period had experienced recurrent adhesional ileus. Each condition had been successfully treated by conservative treatments. In June 2008, he was admitted to our hospital again, complaining of abdominal pain. An abdominal X-ray revealed remarkable dilatation of the small intestine. Because of the repeated adhesional ileus, the boy underwent laparoscopic adhesiolysis. Even after the operation, the boy complained of abdominal pain, which indicated that the laparoscopic operation was unsuccessful. We performed a partial resection of the strictured small intestine under open laparotomy. Until this operation, we had never recognized the causative stricture of the small intestine. After the reoperation, the boy had a good clinical course. The number of laparoscopic surgeries has dramatically increased in pediatric cases lately. Adhesional ileus is considered a good indication for this procedure. However, we experienced a failure of laparoscopic adhesiolysis, which made us realize that there are some limitations in this approach.