単孔式腹腔鏡下にて治療しえた魚骨による小腸穿孔性腹膜炎の1例

A case of perforative peritonitis in small intestine by a fish bone treated by single incision laparoscopic surgery

◆要旨：患者は66歳，男性．右下腹部痛を主訴に当院救急外来を受診した．来院前日の夜間にブリと，ひれ酒を摂取したとのことであった．来院時，右下腹部に軽度の圧痛と反跳痛を認めたために腹部CTを施行した．小腸内に高吸収域の線状陰影を確認した．また周囲腸管の壁肥厚も認め，病歴と合わせて魚骨による小腸内異物と診断した．腹部症状は軽度であり，保存的に観察したが翌日に症状が増悪し，異物による小腸穿孔性腹膜炎と考えて緊急手術を行った．手術は単孔式腹腔鏡下にて穿通した魚骨の除去，小腸壁の修復を行った．術後は著変なく経過し，第5病日に退院となった．小腸内異物による穿孔性腹膜炎に対する単孔式腹腔鏡下手術は，従来の腹腔鏡下手術と比べて切開創の延長を必要とせず，整容性においても優れていると考えられた．

　A 66-year-old male was admitted because of right lower abdominal pain. He ate a yellowtail and drunk liquor with a paffer fin last night. The abdominal CT scan revealed thick small intestine with a linear calcified material inside, possibly a fish bone. Since the abdominal pain was not prominent and inflammation was slight at admission, he was closely observed then. On the next day his abdominal pain and inflammation got worse and emergency operation by single incision laparoscopic surgery was underwent. Perforating fish bone was identified and then we drew the lesion outside the abdominal cavity through 30mm navel incision. Fish bone was removed under direct vision and the perforated site was closed by suture. Postoperative course was uneventful and he discharged on the 5th day after the surgery. The single incision laparoscopic surgery needs shorter incision and is thought to be cosmetically preferred to the conventional approach in perforative peritonitis due to intestinal foreign bodies.