腹腔鏡下に摘出した経皮経肝穿刺による腹腔内伏針の1例

Laparoscopic extraction of intra-hepatic foreign body migrated via abdominal wall : A case report

◆要旨：患者は40歳台，男性．一過性の右上腹部痛にて前医を受診した．CT検査で肝内に異物を認め，当科紹介となった．精査で長径3.5cmの肝内に迷入する針状異物を認め，今後の膿瘍形成などを考慮し摘出術の方針とした．腹腔鏡下に観察すると腹膜と肝臓との間に索状物を認め，体壁からの迷入異物と診断した．X線透視も併用し肝下面に異物の先端を確認した．消化管との瘻孔などはなく，鉗子で異物を摘出した．術後合併症はなかった．術前の問診からは穿刺既往を確認できなかったが，摘出物から患者が仕事で用いるグラインダー用カップブラシと診断した．腹腔内異物の中でも肝内異物は比較的稀であり，経皮経肝的に迷入した極めて稀な1例を経験したので報告する．

　A man in his forties was referred to our hospital because of a right upper abdominal pain during exercise. Abdominal X-ray and CT scan revealed a piece of metallic body in the liver parenchyma. Laparoscopic exploration was performed and the tip of metallic body was identified under the quadrate lobe of the liver. With an additional 5-mm working port added at the epigastric region, laparoscopic extraction of the foreign body was performed. Metallic body, measuring 3.5 cm in length, was extracted from the liver. The patient was discharged on postoperative day 2 without any complication. This needle-shaped metallic body turned out to be a piece of cup-brush from disk-grinder, which most likely penetrated to liver parenchyma through abdominal wall.