肝膿瘍破裂による汎発性腹膜炎に対する腹腔鏡下洗浄ドレナージ術後に内因性眼内炎となった1例

A case of endophthalmitis following panperitonitis due to liver abscess rupture treated by laparoscopy

◆要旨：患者は68歳，男性．既往歴は糖尿病．発熱の原因精査目的に入院した．腹部造影CTで，肝膿瘍破裂による腹膜炎と診断し，腹腔鏡下洗浄ドレナージ術を施行した．血液培養ではKlebsiella pneumoniaeを検出した．術後10日目に右眼内因性眼内炎となり，大学病院へ転院し水晶体摘出術，硝子体切除術を施行され，眼科術後10 日目で当院へ再入院した．その後問題なく，初回の入院から第30病日に退院した．肝膿瘍破裂の汎発性腹膜炎に対し，腹腔鏡下手術で救命しえた．しかし，腹腔内圧上昇（気腹）が，細菌汚染を増悪し，内因性眼内炎の発症に関与した可能性が示唆されたため，若干の文献的考察を加え報告する．

　A 68-year-old male with diabetes mellitus was admitted to our hospital because of high fever. An abdominal computer tomography showed a gas-containing abscess within the left lobe of the liver, ascites, and free air in the abdominal cavity. The patient was diagnosed with panperitonitis due to the rupture of the liver abscess, and an emergency laparoscopic drainage was performed. The blood culture yielded Klebsiella pneumoniae. Although he had a severe infection, his condition dramatically improved after the operation. He had a right metastatic Klebsiella pneumoniae endophthalmitis on the postoperative day 10. He was transferred to another hospital for ophthalmic surgery. His endophthalmitis had improved, and the light perception remained in the right eye. He was readmitted to our hospital. After the ophthalmic surgery, he made steady progress and was discharged from our hospital 30 days after the first admission. Our report may suggest that laparoscopic drainage is effective against panperitonitis due to the rupture of the liver abscess. It is, however, notable that carbon dioxide pneumoperitoneum may increase a risk of bacterial translocation from the peritoneal cavity into bloodstream, resulting in endophthalmitis.