外傷性横行結腸穿孔に対して腹腔鏡補助下手術を施行した1例

A case of traumatic transverse colon perforation treated by laparoscopically assisted surgery

◆要旨：患者は84歳，女性．軽自動車同士の接触事故で救急搬送された．搬送時には臍周辺の疼痛と腹部全体の反跳痛を認めた．腹部CTでfree airを認めたが穿孔部の特定は困難であった．外傷性消化管穿孔と診断し，穿孔部検索をかねて腹腔鏡下手術を選択した．横行結腸中央に約2cm大の穿孔があり，穿孔部を中心に腹腔内全体に食物残渣を認めた．穿孔部の仮縫合と腹腔内全体の洗浄・検索を行った後に，腹腔外操作で改めて穿孔部を縫合閉鎖した．術後経過良好で16日目に退院となった．外傷性大腸穿孔に対し，腹腔鏡補助下手術の選択が有用であった．

　The patient was an 84-year-old female. She had a history of surgery for early gastric cancer. She was brought to our hospital by ambulance due to a traffic accident. On the initial consultation, peri-umbilical pain and rebound tenderness of the abdomen were observed. Abdominal CT revealed free air, but it was difficult to identify the site of perforation. Under a diagnosis of traumatic perforation of the digestive tract, laparoscopic surgery was selected to investigate the site of perforation. At the center of the transverse colon, a perforation measuring approximately 2 cm was detected, with a large volume of contaminated ascites. After the abdominal cavity was lavaged and investigated, the perforated site was sutured by extraperitoneal procedure. The postoperative course was favorable, and the patient was discharged 16 days after surgery. Laparoscopically assisted surgery was useful for traumatic colon perforation.