単孔式腹腔鏡下手術にて摘出した腹腔内金属異物の1例

A case of intraperitoneal metal foreign body removed by single-port laparoscopic surgery

◆要旨：患者は68歳，男性．20XX年11月に腰背部痛を自覚し近医を受診した．尿路結石を疑われ当院泌尿器科に紹介となるがCT検査にて尿路結石の所見は認めず，腹腔内異物を認め消化器内科に紹介された．なお，整形外科も受診し腰背部痛は腰椎症の診断となった．腹腔内異物に関しては魚骨などの腹腔内に穿孔した異物が疑われ，当科に紹介となった．CTでは周囲脂肪織濃度の上昇やfree airは認めず，過去に腹部症状もなかった．翌年3月に単孔式腹腔鏡下異物除去術を施行した．画像所見を認めた部位の大網は肥厚しており，肥厚部を含めた大網部分切除とした．切除標本より約11mmの針金状の異物を認めた．異物は成分分析の結果，調理器具などで汎用されるステンレス鋼と推測された．

　A 68-year-old man was introduced to our hospital because of lower back pain. Urinalysis and echography showed no findings of urolithiasis. Abdominal CT scan revealed linear calcifications near the gastric wall. A fish bone perforated in the abdominal cavity was suspected and the patient was referred to surgery. CT scan showed no inflammatory findings around the stomach. Patients did not have epigastric pain in the past. Single-port laparoscopic foreign body removal was performed. The omentum was partially thickened. We partially excised the omentum using an ultrasonic coagulotomy. The abdominal foreign body was metal. As a result of analysis by component analysis, the metal was stainless steel. This case was considered to be an intra-abdominal foreign body caused by ingesting fragments of cooking utensils through the mouth.