CPT-11投与後に発生した門脈ガス血症に対して腹腔鏡所見をもとに保存的治療が可能と判断した1例

Hepatic portal venous gas caused by CPT-11, which was resolved by conservative treatment based on the laparoscopic findings : a case report

◆要旨：患者は66歳，男性．胃癌術後の肝転移に対してCPT-11を投与中，腹痛があり入院した．CTで門脈ガスを認めたが，腹部所見は軽度で循環動態も落ち着いていた．化学療法中のハイリスク症例に対して保存的治療の可能性を追求するため，診断・治療の目的に腹腔鏡下手術を施行した．術中所見では20cmほどの小腸に限局した浮腫を認めるのみで壊死はなかったため，保存的治療が可能と判断した．門脈ガス血症は腸管壊死に起因することが多く，一般的には致死的な疾患であるが，近年は保存的治療で改善した症例報告も散見される．しかし，現在の検査基準のみでは緊急手術か保存的治療かの判断に迷うことも多く，本症例のように稀ではあるが，CPT-11投与による腸炎が門脈ガス血症の起因になったと考えられるハイリスク症例では，腹腔鏡下に腸管の状態を観察することも1つの選択肢になりうると考えられた．

　We present a 66 year-old man who was administered CPT-11 for multiple liver metastasis after total gastrectomy. He visited our hospital for chief complaints of sudden abdominal pain CT scans showed hepatic portal venous gas（HPVG）, but his vital sign was stable. We performed diagnostic laparoscopic surgery because he had many complications . The intraoperating finding was the reddening and edema of the localized small intestine with no necrosis, so we evaluated that conservative management was possible. HPVG is often caused by bowel necrosis, and is considered to be a critical disease, but recently some reports have stated that HPVG could be treated by conservative management according to circumstances. When decision about the treatment of HPVG is difficult, laparoscopic surgery for the purpose of observation of the bowel can be a useful procedure. In this case, we suspect the cause of HPVG maybe localized bowel inflammation and inner pressure elevation of the small intestine due to CPT-11.