バリウム後腹膜炎に対し腹腔鏡下手術を施行した1例

Laparoscopic surgery for barium retroperitonitis : A case report

◆要旨：患者は70歳，女性．潰瘍性大腸炎関連大腸癌の診断で手術予定であった．術前のバリウム注腸検査中に直腸癌部より穿通してバリウム後腹膜炎を発症したため，緊急で腹腔鏡下手術を施行した．術中所見では後腹膜への広範囲なバリウムの漏出を認めた．大腸全摘術ならびに回腸単孔式人工肛門造設を行い，生理食塩水にて洗浄ドレナージを行った．術後経過は良好で，術後21日目に退院となった．バリウム後腹膜炎はバリウムが腸管外に漏出した穿孔性後腹膜炎であり，重篤な病態である．今回筆者らは，腹腔鏡下手術にて良好な経過を得たバリウム後腹膜炎の1例を経験したため文献的考察を加えて報告する．

　A 70-year-old woman was referred to our hospital because of ulcerative colitis-associated colorectal cancer and elective operation was planned. During preoperative barium enema test, perforation was confirmed from the cancer, causing barium retroperitonitis and emergency laparoscopic surgery was performed. Intraoperative finding showed widespread leakage of barium in the retroperitoneum. We performed a total proctocolectomy with an end ileostomy and the retroperitoneum was lavaged with saline. Postoperative course was uneventful, and the patient was discharged on the 21st postoperative day. Barium retroperitonitis is caused by perforation of gastrointestinal tract and leakage of barium to the retroperitoneum. It is a severe condition with poor prognosis. We experienced a patient with barium retroperitonitis who was treated successfully by emergency laparoscopic surgery.