術前診断し得た虫垂憩室穿孔に対しlaparoscopic interval appendectomyを施行した1例

A case of perforated appendiceal diverticulitis diagnosed preoperatively and treated by laparoscopic interval appendectomy

◆要旨：患者は52歳，男性．2009年12月，右下腹部痛と同部腫瘤を自覚し当科を受診した．CT検査で虫垂先端に45mmの腫瘤を認め，虫垂膿瘍の診断で入院となった．保存的加療を行った後，内視鏡下虫垂造影，造影後CT検査などで，虫垂憩室穿孔による虫垂膿瘍の診断に至った．保存的加療から12週後，laparoscopic interval appendectomyを施行した．膿瘍は改善しており，手術操作に難渋せず虫垂切除を完遂できた．術後合併症はなかった．虫垂憩室穿孔による虫垂膿瘍を術前に診断し，laparoscopic interval appendectomyを安全に行うことができた症例を経験したので報告する．

　A 52-year-old male patient visited our hospital with a chief complaint of right lower abdominal pain and mass in December 2009. Biochemical blood examination showed increased C reactive protein. Computed tomography（CT） showed mass-forming appendicitis. At first, we diagnosed as appendiceal abcess and treated conservatively. Colonoscopy and radiographic contrast enema of the appendix performed after admission revealed that appendiceal abcess was due to perforated appendiceal diverticulitis. Laparoscopic interval appendectomy was planned with an interval of 12weeks after conservative therapy. The operative findings revealed that abcess was already improved, and laparoscopically, dissection of the adhesion and appendectomy were easily performed. The postoperative course was satisfactory and uneventful. We report a case of appendiceal abcess due to a perforated appendiceal diverticulitis diagnosed preoperatively and treated by laparoscopic interval appendectomy.