化学療法中に腹腔鏡下手術で摘出した腹腔内迷入IUDの1例

A case of laparoscopic removal of translocated intrauterine device from peritoneal cavity

◆要旨：患者は55歳，女性．第2子分娩後に他院で31歳時に子宮内避妊具（IUD）を挿入したが，その3か月後に自然妊娠し，第3子を経腟分娩で出産した．52歳時にStageⅣ肺癌の診断を受け，化学療法中であった．1か月前から続く右上腹部痛の増悪と発熱を主訴に当院を受診し，CTで右上腹部にIUDを認めた．IUDが感染源となっている可能性があり，早期の摘出が必要との判断で当科に摘出依頼があり，腹腔鏡下手術を施行した．IUDは大網に強固に癒着していたため大網を一部切除し，Lippes Loop IUDを摘出した．術後3日目に退院し，術後12日目より化学療法を再開した．腹腔鏡下手術は低侵襲であり，化学療法の休薬期間中にも実施可能であった．

We experienced a case of laparoscopic removal of an intrauterine device（IUD） translocated into the peritoneal cavity. The patient was a 55-old-year female. She had an IUD implanted at a hospital at 31 years of age. Three months later, she became pregnant spontaneously and delivered a third baby. She was undergoing chemotherapy because she was diagnosed with stage IV lung cancer at the age of 52. She had a fever with an aggravated right upper abdominal pain one month ago and visited the emergency room of our hospital. An IUD was recognized just below the right anterior abdominal wall, and the patient was referred to our department. Since the IUD might potentially become the source of infection during chemotherapy, its early removal was considered necessary and laparoscopic surgery was carried out. The IUD adhered to the omentum but was not buried in it. The IUD was exposed just below the abdominal wall and was easy to detect. Since the adhesion between the IUD and omentum was severe, part of the omentum was resected laparoscopically and the Lippes Loop IUD was removed. The patient was discharged from the hospital on postoperative day 3 with an uneventful clinical course. On postoperative day 12, chemotherapy was resumed. Laparoscopic surgery is expected to be widely applied for not only evaluation of treatment response during chemotherapy but also treatment for adverse events during chemotherapy.