腹腔鏡下摘出術が可能であった腹壁伏針の1例

Laparoscopic removal of needle from abdominal wall

◆要旨：患者は73歳，女性．他院での腹部X線撮影で下腹部に縫い針様の金属異物を指摘され紹介された．腹部CT検査で下腹部腹壁内に針状の金属異物を認め，腹直筋鞘の背側で腹膜に接するように位置していた．体表から摘出を試みた場合に針を腹腔側へ押し込む可能性が危惧されたため，腹腔鏡下に伏針摘出を試みた．腹腔鏡により腹膜前腔の直針を良好に観察し遺残なく摘出した．針は4cmの縫い針であった．CT検査で詳細な位置を検討することで計画的に腹腔鏡下手術を選択し，良好な視野で摘出することが可能であった．腹膜前腔に到達した腹壁伏針では良好な視野でより安全に摘出できる可能性が示された．

　Needles inside the abdominal wall are usually removed by skin incisions. We report a case of a needle in the abdominal wall that was removed laparoscopically. A 73-year-old woman was referred to our facility with a needle-like metallic foreign body in her lower abdomen on abdominal radiography. On computed tomography （CT）, the object was found to be in the abdominal wall, mostly in contact with the peritoneum under the rectus abdominis muscle sheath. It was speculated to be a needle, and surgical removal was deemed necessary. Considering the risk of pushing the needle further into the abdominal cavity with the trans-skin approach, we planned laparoscopic removal of the needle. Laparoscopically, the presence of a straight needle was confirmed in the preperitoneal space, and it was removed completely. It was a 4-cm sewing needle. Thus far, to our knowledge, there have been no Japanese reports of laparoscopic surgery for removing needles or metallic foreign bodies retained in the abdominal wall. By detailed examination of the foreign body position on CT, we were able to perform laparoscopic removal of the needle with good visual field. Thus, laparoscopic approach may be useful even in cases where needles have not reached the abdominal cavity.