消化管を穿孔したにもかかわらず無症状で経過し腹腔鏡下に摘出可能であった金属繊維誤飲の1例

Laparoscopic removal of ingested metallic filament which penetrated from gastrointestinal tract without symptom : a case report

◆要旨：患者は57歳，男性．飲食店経営．金網洗浄用ワイヤーブラシの金属繊維を誤飲し，無症状であったが翌日受診した．腹部単純X線検査で金属繊維を確認したが，上部消化管検査では確認できなかったため経過観察とした．2週間後の腹部単純X線，CT，全腸管造影検査で金属繊維は腸管外の腹腔内と判断し腹腔鏡下手術を施行した．腹腔内には腹水や出血，癒着はなく，金属繊維は大網内に確認でき周囲臓器の損傷もみられなかったため，摘出のみで手術を終了した．術後経過は良好であった．金属繊維の誤飲を確認でき，無症状で腸管外に穿孔した経過を確認できることは非常に稀であると思われ報告する．

　A 57-year-old man visited our hospital because of ingestion of metallic filament the previous evening. He had no symptom and abdominal X-ray film pointed out a foreign body like a metallic filament at the middle upper abdomen. However, the metallic filament was not detected by upper gastrointestinal fiberscope. The patient was followed-up at home for two weeks and abdominal X-ray films still showed the foreign body like a metallic filament at the left upper abdomen. Computed tomography showed a small linear high density foreign body in the fatty tissue outside the intestine. Gastrografin enema showed that the foreign body was outside the intestine. From these findings, we diagnosed penetration of the metallic filament from the gastrointestinal tract and performed laparoscopic operation. Laparoscopical findings demonstrated the metallic filament in the fatty tissue of the omentum and this filament was safely removed. The extracted metallic filament was 20 mm long. The postoperative course was uneventful and the patient was discharged 3 days after the operation.