腹腔鏡診断が有用であった魚骨による不顕性穿孔に続発した大網放線菌症の1例

Usefulness of laparoscopy for the diagnosis of actinomycosis of the omentum caused by silent fishbone perforation

◆要旨：患者は66歳，女性．腹痛を自覚し受診した．来院時，臍周辺に腹膜刺激症状を認め，造影CTで腹腔内に鋭利な石灰化陰影と膿瘍形成を認めた．確定診断には至らなかったが，急性腹症の診断で腹腔鏡下手術を施行した．開腹所見では，腹腔内に大網腫瘤を認め，内部に魚骨と膿瘍形成を認めたが，消化管に穿孔部を認めなかった．大網膿瘍と診断し，これを切除した．明らかな消化管穿孔を認めず，魚骨の不顕性穿孔による大網膿瘍と診断し，病理組織学的検査で放線菌症と診断された．大網放線菌症は稀な疾患であり，文献的考察を加えて報告する．

　A 66-year-old woman visited our department with abdominal pain. Abdominal computed tomography showed a sharp calcification and abscess. We could not make a definitive diagnosis and thus performed laparoscopic surgery with a suspicion of acute abdomen. Laparoscopic findings demonstrated a mass composed of abscess and omentum with fishbone inside it. There was no evidence of perforation in the intestinal wall. No other abnormalities were found, and the mass was resected. We concluded thatthe mass was caused by a silent fish bone perforation which was histologically diagnosed as actinomycosis. The postoperative course was uneventful and the patient was discharged 7days after the surgery.