日本未熟児新生児学会雑誌　第26巻第1号　89～93頁（2014年）

日本未熟児新生児学会雑誌　26(1)：89-93；2014　

受付日：平成25．04．10

受理日：平成25．07．08

臍帯潰瘍を合併した消化管閉鎖症3例の治療経験

Umbilical Cord Ulceration with Intestinal Atresia：Report of 3 Cases

＊1聖マリアンナ医科大学横浜市西部病院　小児外科，＊2聖マリアンナ医科大学横浜市西部病院　新生児科，＊3聖マリアンナ医科大学　小児外科

＊1Department of Pediatric Surgery, St.Marianna University Yokohama Seibu Hospital, ＊2Department of Neonatology, St.Marianna University Yokohama Seibu Hospital, ＊3Department of Pediatric Surgery, St.Marianna University School of Medicine

古田繁行＊1・佐藤英章＊1・正木　宏＊2・鈴木真波＊2・横田伸司＊2・丸山和哉＊2・北川博昭＊3

Shigeyuki FURUTA＊1，Hideaki SATO＊1，Hiroshi MASAKI＊2，Manami SUZUKI＊2，Shinji YOKOTA＊2，Kazuya MARUYAMA＊2，Hiroaki KITAGAWA＊3

Key Words：umbilical cord ulcer，bowel atresia，intrauterine hemorrhage，non-reassuring fetal status

　臍帯潰瘍を合併した高位消化管閉鎖症の3例を経験した。症例1 は在胎33週に消化管閉鎖症と診断され，34週に至り胎児機能不全で緊急娩出された体重2,870gの男児。羊水は血性であり，児は著しく貧血様で，臍帯に形成された潰瘍の底部で臍動脈が破綻していた。児は多発腸閉鎖手術により救命されたが，低酸素性の重度脳障害を遺した。症例2は切迫早産のため在胎29週で出生した体重1,134gの男児で，症例3 は前期破水のため在胎33週で出生した体重2,076gの女児。両者の臍帯にも潰瘍形成を認めたが血性羊水は認めず，十二指腸および空腸閉鎖症の手術を受け，脳障害なく生存を得た。消化管閉鎖症に合併する臍帯潰瘍の成因は不明であるが，早期診断が可能であることを示唆する報告もある。出生前診断された腸閉鎖症については，上記病態発生の可能性を念頭に置き妊娠母体および胎児を管理する必要がある。

　We report three infants with intestinal atresia associated with umbilical cord ulceration. Case1：A boy who was delivered at 34 week’s gestation weighing 2,870g was noted to show bloody amniotic fluid at delivery. The infant was severely anemic. The umbilical artery was ruptured in the floor of an ulcer in the umbilical cord. The infant underwent surgery at 16 days of age to repair multiple intestinal atresias. He later developed severe sequelae due to cerebral hypoxia, most likely as a consequence of the severe anaemia. The other two babies, born with abnormal urgent deliveries（Case 2：A male infant weighing 1,134g was delivered at 29.5 weeks gestation due to threatened premature delivery. Case 3：A female infant weighing 2,076g was delivered at 33.1 weeks gestation due to premature rupture of the membranes.），showed no bloody amniotic fluid, but they had umbilical cord ulceration. They were alive without any signs of sequelae after surgery for their intestinal atresias.
　A serious condition caused by umbilical cord ulceration associated with such high small intestinal atresia is still relatively unknown. Therefore, when intestinal atresia is diagnosed prenatally, one must consider possible existence of this life threatening pathology while conducting prenatal examinations.