腹腔鏡下虫垂切除術中に発症したラテックス製手袋によるアナフィラキシーショックの1例

A case of anaphylactic shock caused by a latex surgical glove during laparoscopic appendectomy

◆要旨：患者は22歳，女性．急性虫垂炎に対して腹腔鏡下虫垂切除術中，ラテックス製手術用手袋を腹腔内に挿入し，切除した虫垂を回収したところ，突然換気不良となりショック状態となった．喘息発作を疑い，ステロイドを投与したが改善しなかったため，皮膚に蕁麻疹様発疹は認めなかったが，アナフィラキシーショックを疑い，エピネフリンを投与したところ，全身状態は改善した．術後のアレルギー検査で，ラテックス抗原特異IgE抗体価が上昇しており，術中に腹腔内に挿入したラテックス製手袋がアナフィラキシーショックの原因と診断した．

　アレルギー疾患を有する患者には，詳細な病歴聴取を行い，適宜ラテックスフリーで手術を行うことが肝要である．

　A 22-year-old woman with right lower abdominal pain was admitted to our hospital. She was diagnosed as acute appendicitis and laparoscopic appendectomy was planned. During the operation, we used a latex surgical glove for the retrieval of resected appendix from the abdominal cavity. Few minutes after the removal, she suddenly presented symptomatic shock and respiratory failure. Anaphylactic shock was suspected, even without urticaria rash. Immediate intravenous injection of epinephrine improved the general condition and the operation was accomplished. We concluded that the anaphylactic shock was caused by latex allergy from surgical glove as a result of postoperative elevation of the serum level of latex-specific type E immunoglobulin. Furthermore, we found that that she had experienced some redness in her hand after using rubber gloves.

　In conclusion, it is important to take a detailed medical history and establish a latex free environment during laparoscopic surgery especially for the patient who had allergic disease.