外傷性小腸穿孔・腹腔内出血に対して腹腔鏡下手術が有用であった1症例

Successful laparoscopic assisted repair of jejunal perforation and hemostasis of mesenteric hemorrhage following blunt abdominal trauma

診断が困難であった外傷性腹部損傷の59歳，男性．循環動態が安定しているため，まず診断的腹腔鏡を行い，腸管膜損傷による動脈性出血およびその血流支配領域の循環不全，さらに他部位に小腸穿孔を確認した．引き続き緊急処置へと移行し，腹腔鏡下にて縫合止血・穿孔部一時閉鎖を行い，まず循環動態の悪化・腸液による腹腔内の汚染拡散防止を優先した．その後，約3.5cmの小開腹を置き，体外操作で直視下に穿孔部および壊死腸管の修復を行った．その後，再気腹・大量洗浄を施行し，手術を終了した．腹腔鏡下手術の利点である低侵襲性・拡大視効果を損なうことなく手術を完遂し，術後9日目に軽快，退院となった．外傷性小腸穿孔・腹腔内出血症例でも，適応を選び，局所制御（止血，汚染拡散防止）を優先させ徹底した腹腔内洗浄を行うことで腹腔鏡下手術が有効であった症例を経験したので報告する．

　We performed laparoscopically surgery for jejunal perforation and mesenteric hemorrhage following blunt abdominal trauma. The patient was a 59-year-old man. On admission, there were no signs of peritonitis, no abnormal laboratory data. Although CT examination showed a small amount of mesenterium hematoma in the left abdominal region, there was no suggestion of perforation. The patient complained of intermittent abdominal pain since the day of admission. A presumptive diagnosis of suspected perforative peritonitis or mesenteric hemorrhage was made and diagnostic laparoscopy was performed. In the abdominal cavity, jejunal perforation and mesenteric hemorrhage were observed. Laparoscopic assisted repair of jejunal perforation and hemostasis of mesenteric hemorrhage were performed. The patients was discharged 9 days after the operation. This laparoscopic technique may be safe and useful even in cases of emergency if it is possible to lavage the contaminated peritoneal cavity with saline sufficiently and keep good visualization under a stable cardiovascular condition, this laparoscopic technique may be safe and useful on a therapeutic level.