横隔膜下膿瘍を伴う小児急性虫垂炎に対する腹腔鏡下手術の1例

A pediatric case of laparoscopic appendectomy for acute appendicitis with subphrenic abscess

◆要旨：患者は10歳，女児．腹痛，嘔吐，下痢を主訴に当院小児科を受診した．腹部CT検査で横隔膜下膿瘍，Douglas窩膿瘍を伴う急性虫垂炎と診断され当科に紹介となった．発熱と脱水，白血球およびCRP上昇，電解質の異常を認めた．補液により脱水の改善と電解質の補正を行った後に，腹腔鏡下虫垂切除，生理食塩水8,000mlによる腹腔内洗浄，ドレナージを施行した．術後，創感染を認めたが，ドレナージで改善し，創の整容性は保たれていた．横隔膜下膿瘍を合併した急性虫垂炎に対する腹腔鏡下手術の報告は文献検索上みられなかった．腹腔鏡下手術は小さな創で虫垂切除および腹腔内全体の観察と洗浄が可能であり，有用であると考えられた．

　A 10-year-old girl, who had severe abdominal pain, nausea, and diarrhea, visited our hospital. Computed tomography （CT） showed appendicitis with subphrenic and Douglas'abscess. Her physiological state was hypovolemic and biochemical blood examination showed electrolyte disorder and increased white blood cell and C reactive protein. After correction of electrolyte disorder by intravenous drip infusion, emergency operation was performed. We chose laparoscopic appendectomy to minimize the incision and to conduct lavage throughout the abdominal cavity. We performed jet irrigation with 8,000ml saline and drainage after appendectomy. Despite having post operative wound infection, her wound healed cosmetically by incisional drainage. From our knowledge, this is the first report of a laparoscopic appendectomy for appendicitis with bilateral subphrenic abscess. When the inflammation spread throughout the abdominal cavity, laparoscopic appendectomy may be recommended instead of laparotomy because of its good visual field and cosmetic advantages.