腹腔鏡下に修復しえた魚骨による小腸穿孔の1手術例

A case of small intestinal perforation by ingested fish bone successfully operated under laparoscopy

◆要旨：患者は77歳，男性．下腹部痛を主訴に当院救急外来を受診した．腹部理学所見では，右下腹部に限局した反跳痛が認められ，腹部単純CTで小腸内に異物を認めた．病歴聴取で数日前にカレイを食したことが判明した．以上より，魚骨による小腸穿孔と診断し入院となった．腹部症状，炎症所見が軽度で，腹部CTで腹水，膿瘍形成がないことから経過観察とした．3日後，症状・炎症所見は変化しなかったが，腹部CTで魚骨は移動しておらず，小腸壁の肥厚が増悪したため手術の方針とした．腹腔鏡下に小腸壁を穿通している魚骨を摘出し，穿孔部を縫合した．術後経過は良好で，第7病日に退院となった．魚骨による消化管穿孔に対し，早期診断ができ，腹腔鏡下手術を完遂できた稀な症例を経験したので報告する．

　The case is a 77-year-old man. He came to our hospital with a chief complaint of lower abdominal pain. By abdominal physical examination, localized rebound tenderness was found in the right lower quadrant, and abdominal simple CT showed a foreign body in the small intestine. In a history taking, it was recognized that he ate a flatfish a few days ago. He was diagnosed as small intestinal perforation by ingested fish bone and was admitted to our hospital. Because there were no abdominal symptoms, no ascites, no abscess formation by abdominal CT, and inflammatory findings were slight, we chose conservative therapy. Three days later, the symptom and the inflammatory findings did not improve. Abdomitted CT revealed that the thickness of the small intestinal wall increased and the fish bone was not moved. We chose to operate. We removed the fish bone which penetrated the small intestinal wall and repaired the perforation by laparoscopic procedure. The postoperative course was good and he was discharged on the seventh day after admission.

　For small intestinal perforation by fish bone, we report a rare case in which early diagnosis was possible and operation under laparoscopy was possible.