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Volume 73, Issue 1 （January 2024）

麻酔 73巻1号（2024年1月発行）

Japanese English

症例報告

虫垂切除術中に循環不全を呈した小児多系統炎症性症候群（MIS-C）の麻酔経験 Anesthetic Experience with Multisystem Inflammatory Syndrome with Intraoperative Circulatory Failure in Appendectomy 吉野和久 ¹ , 尾崎温 ¹ , 長田宜子 ¹ , 峰尾恵梨 ² , 松田弘美 ¹ , 岡本浩嗣 ¹ Kazuhisa YOSHINO ¹ , Atsushi OZAKI ¹ , Yoshiko OSADA ¹ , Eri MINEO ² , Hiromi MATSUDA ¹ , Hirotsugu OKAMOTO ¹ ¹北里大学医学部麻酔科学学 ²北里大学医学部小児科学 ¹Department of Anesthesiology, Kitasato University School of Medicine ²Department of Pediatrics, Kitasato University School of Medicine キーワード：多系統炎症性症候群 , 新型コロナウイルス感染症 , 虫垂炎 , 急性腹症 Keyword: multisystem inflammatory syndrome , Coronavirus disease 2019 , appendicitis , acute abdomen pp.69-74

発行日 2024年1月10日 Published Date 2024/1/10

DOI https://doi.org/10.18916/masui.2024010014

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要旨

　9歳，女児。虫垂炎の疑いで手術となったが麻酔導入直後より循環不全となり，その維持に難渋した。腹腔内は明らかな虫垂炎所見は認めず，術後の問診で両親にCOVID-19の既往歴が判明し，精査の結果小児多系統炎症性症候群（MIS-C）の診断に至った。急性腹症を疑い緊急手術になる小児患者は，本病態も考慮し家族歴や既往歴を含めた問診や全身診察を行う必要がある。

　9-year-old Japanese girl with no medical history who had experienced diarrhea and vomiting for 7 days was diagnosed with appendicitis and underwent emergency surgery. After the induction of general anesthesia, uncontrollable hypotension was observed；septic shock due to perforation of the appendix was suspected. A laparoscopic examination of the abdominal cavity revealed no appendicitis, only intestinal edema and ascites. The patient’s parents were interviewed again after the surgery, revealing that approx. 4 weeks prior to the patient’s admission the parents had been infected with COVID-19 and the patient had a fever. The patient was diagnosed with multisystem inflammatory syndrome with intraoperative circulatory failure（MIS-C）, and her general condition improved with immunoglobulin and steroids.