| 日本新生児成育医学会雑誌 第37巻 第1号 92 ～ 96頁（2025年） |
| 受付日：2024．02．16 |
| 受理日：2024．05．22 |
| 食道穿孔と鑑別を要した医原性梨状窩穿孔の超低出生体重児例 |
| A Case of Iatrogenic Piriform Fossa Perforation Requiring Differentiation from Esophageal Perforation in an Extremely Low Birth Weight Infant |
| ＊ 1 福島県立医科大学 小児科学講座，＊ 2 福島県立医科大学附属病院 小児外科 |
| ＊ 1 Department of Pediatrics, Fukushima Medical University School of Medicine， ＊ 2 Department of Pediatric Surgery, Fukushima Medical University Hospital |
| 湯田優衣＊ 1・蛭田 俊＊ 1・市川弘隆＊ 1・小笠原啓＊ 1・郷 勇人＊ 1・田中秀明＊ 2・細矢光亮＊ 1 |
| Yui YUDA ＊ 1，Shun HIRUTA ＊ 1，Hirotaka ICHIKAWA ＊ 1，Kei OGASAWARA ＊ 1， Hayato GO ＊ 1，Hideaki TANAKA ＊ 2，Mitsuaki HOSOYA ＊ 1 |
| Key Words：piriform fossa perforation，gastric tube insertion，neonate |
| 新生児の梨状窩穿孔はまれである。我々は，胃管挿入の際に発生したと考えられる梨状窩穿孔の超低出生体重児
を経験したので報告する。症例は，在胎23 週4 日，体重494g で出生した女児で，生後7 分に気管挿管されたが，
胃管挿入に難渋し胸腹部X 線で胃管は胸腔内への迷入を認めた。食道穿孔や梨状窩穿孔を疑い喉頭内視鏡を施行
したところ，両側梨状窩に穿孔を認めた。喉頭展開し食道入口部を視認しながら胃管を誘導すると，抵抗なく胃内
に挿入でき，胃管迷入は梨状窩穿孔によるものと判明した。その後，経腸栄養は順調に増量でき，梨状窩穿孔に起
因する感染症等なく，穿孔部は保存的に治癒した。 梨状窩穿孔は食道穿孔との鑑別を要し，確定診断には喉頭内視鏡による観察が有用である。また，梨状窩穿孔が 判明した場合は，喉頭展開下に食道入口部を視認しつつ胃管を挿入し，穿孔部は自然閉鎖を期待し保存的に経過観 察する方針がよいと考えられた。 |
| Perforation of the piriform fossa in neonates is rare. Here, we report a case of piriform fossa perforation that appeared to have occurred during gastric tube insertion in an extremely low birth weight（ 494 g） female infant born at 23 weeks of gestation. She was intubated 7 minutes after birth, but the gastric tube insertion was difficult, and a chest and abdominal X-ray showed that the tube had strayed into the thoracic cavity. Due to suspected perforation of the esophagus or the piriform fossa, laryngeal endoscopy was performed, which revealed perforation of bilateral piriform fossa. By expanding the larynx with a laryngoscope blade, the pharyngoesophageal junction could be observed while the gastric tube was fed through, and the tube was successfully inserted into the stomach without resistance. The cause of the gastric tube initially straying into the thoracic cavity was due to perforation of the piriform fossa. Enteral nutrition was increased, and the perforation was closed with conservative treatment without infection. Perforation of the piriform fossa must be differentiated from perforation of the esophagus, and laryngeal endoscopy is useful in making a definitive diagnosis while considering this differentiation. If perforation of the piriform fossa is identified, the pharyngoesophageal junction should be monitored by dilating the larynx with a laryngoscope blade while inserting the gastric tube, and the perforation should be observed conservatively with the expectation that it will close. |