日本未熟児新生児学会雑誌　第26巻第2号　74～79頁（2014年）

日本未熟児新生児学会雑誌　26(2)：304-309；2014　

受付日：平成25．10．07

受理日：平成26．01．27

胎児期発症の腸重積により出生後早期に消化管穿孔を発症した1 例

A Case of Neonatal Gastrointestinal Perforation Caused by an Intussusception Considered to have Developed during the Fetal Period

千葉県こども病院　新生児未熟児科

Department of Neonatology, Chiba Childrenʼs Hospital

鈴木　学・鶴岡智子・市本景子・伊藤　絢・佐々木　寛・三浦文宏

Manabu SUZUKI，Tomoko TSURUOKA，Keiko ICHIMOTO，Aya ITOH，Hiroshi SASAKI，Fumihiro MIURA

Key Words：intestinal tract expansion，gastrointestinal perforation，intussusception

　症例は在胎38週4 日，体重2,880gで出生した女児である。出生の8 日前から胎児超音波で腸管拡張を指摘されていたが他に妊娠経過に異常を認めず，普通分娩で出生した。出生8時間後に初回哺乳を行ったところ出生13時間後に呻吟と腹部膨隆を認め，単純Ｘ線検査で消化管穿孔と診断され当院に転院して緊急手術を行った。開腹すると小腸は離断しており口側から腸液の漏出を認め，肛側には腸重積症が確認された。手術所見から胎児期発症の腸重積症が原因で消化管穿孔を発症したと考えられた。胎児超音波での腸管拡張は消化管閉鎖を示唆する所見だが，本症例は消化管閉鎖を示唆する症状を認めず全身状態が良好だったため，生後に消化管通過障害の有無に関する精査が行われなかった。症例の経過は胎児超音波にて消化管奇形が疑われた児の周産期管理を再考するに有用であると考えられたので報告する。

　We report a case of neonatal gastrointestinal perforation caused by an intussusception considered to have developed during the fetal period. The patient was a female born at 38 weeks of gestation and weighing 2,880g. Intestinal tract expansion was detected by ultrasound 8 days before birth and just before birth too. However, no other abnormality was found as pregnancy progressed. After first lactation, the patient developed a dyspnea and abdominal distension. She was diagnosed with gastrointestinal tract perforation and underwent an emergency surgery. Newly developed intussusception was confirmed intraoperatively, and gastrointestinal perforation was thought to have been caused by intussusception that developed during the fetal period. Detection of intestinal tract expansion on fetal ultrasound was considered an indication of the need for gastrointestinal interruption. So if intestinal tract expansion was detected on fetal ultrasound, further investigation should be performed after birth, even if the patient did not exhibit any characteristic indicators for gastrointestinal interruption. We report this case because we believe that the progress of this patient would be useful when considering a management policy for neonates with suspected intestinal malformation detected by a fetal ultrasound.