CTで術前診断し腹腔鏡下に修復した魚骨による胃穿孔の1例

Gastric perforation due to fish bone diagnosed by preoperative CT and cured by laparoscopic surgery : a case report

◆要旨：患者は75歳，男性．心窩部の激痛にて当院を受診した．急性汎発性腹膜炎の状態であり，腹部CTにて胃下部前壁から壁外に突出する約3cmの線状高吸収域を認め，魚骨による胃穿孔と診断した．上部内視鏡検査を行ったが， 残渣が多いこともあり，異物や異物の刺入痕跡を確認できなかった．内視鏡による魚骨摘出は困難と思われ，腹腔鏡下に手術を行うことにした． 胃前壁に覆いかぶさった横行結腸と大網を剝離したところ，25mm長の魚骨を認めたため，10mmのトロッカー内を通して摘出した．前庭部前壁の胃穿孔部は腹腔鏡下に縫合閉鎖した．手術時間は67分，出血量は少量であり，術後経過良好にて，第14病日目に退院した．

　A 75-year-old man was examined at our clinic for epigastric pain. Acute diffuse peritonitis was present and abdominal computed tomography revealed a linear, approximately 3-cm, high-density region projecting outside the anterior wall of the lower stomach. Diagnosis of gastric perforation by fish bone was made. Upper endoscopy was performed but neither the foreign body nor traces of its passage could be confirmed due to considerable residue. Endoscopic removal of the fish bone was deemed unfeasible and laparoscopy was conducted. Detachment of the greater omentum and transverse colon covering the anterior gastric wall revealed a 25 mm-long fish bone which was removed via a 10-mm trocar. The perforated region of the anterior vestibular wall was laparoscopically sutured. Operation time was 67 minutes, blood loss was minimal and the patient was discharged on hospital day 14 following satisfactory postoperative progress.