腹腔鏡下に切除した卵管瘤膿腫の1例

Laparoscopic surgery for pyosalpinx : A case report

◆要旨：患者は17歳，女性．右下腹部痛を主訴に来院した．腹部理学所見からは急性虫垂炎が疑われたが，腹部CT所見からは否定的で，産婦人科疾患の可能性も考えられた．保存的治療を開始したが症状が増悪したために診断・治療目的で腹腔鏡下手術を選択した．腹腔鏡下所見から右卵管瘤膿腫による骨盤腹膜炎と診断し，腹腔鏡下に腫大した右卵管切除，骨盤内洗浄ドレナージおよび虫垂切除を施行した．このように女性の急性腹症には産婦人科関連疾患が紛れ込んでいることがあるため，診断に苦慮する症例では腹腔鏡下観察を行い術式を選択することが非常に有用であると考えられた．

　The case is a 17-year-old woman. She came to our hospital with pain in the lower right quadrant. Acute appendicitis was doubted from physical examination, but the findings of abdominal CT scan suggested a gynecological disorder. Because her symptom aggravated though our conservative treatment, we chose operation under laparoscopy in a diagnosis/therapeutic purpose. Laparoscopy revealed pelvic peritonitis due to the right pyosalpinx, and we performed right salpingectomy, washing drainage in pelvis and appendectomy under laparoscope. We concluded that the diagnostic laparoscopy was useful especially in the case of female acute abdomen, since various digestive and gynecological disorders need to be ruled out. Diagnostic laparoscopy is useful for differential diagnosis and performing adequate operation.