イレウス管の管理に注目した柿胃石による食餌性イレウスの1例

Intestinal food-induced obstruction is a rare disease. Diospyrobezoar is one of the main causes. The structure has characteristic CT findings of clear wedge and internal cavernous low density area. Diospyrobezoar sometimes exist with other stones. A 60s-year-old man with abdominal pain and vomiting was introduced to our hospital. CT scan showed the dilated small intestine and two round structures with 3.5cm and 2.5cm in minor axis in the ileum. The patient had been having dried persimmons habitually in this season without artificial teeth. Based on these findings, intestinal diospyrobezoar obstruction was diagnosed. Depressurization by a balloon-tipped long tube was performed prior to surgery. The long tube and 2 structures in the intestine were detected under the laparoscopic examination, and the small intestine at 30cm oral side from two structures was pulled-out through the umbilical incision. Another stone was led to the other one to the oral side manually and a longitudinal incision was made on the anal side of the stones. Not only 2 stones that were identified preoperatively but also 4 small stones were removed. Surgery should be needed to treat diospyrobezoar ileus with a 3.0cm stone in minor axis, and it is essential to consider multiple stones.