腹腔鏡下前立腺全摘除術後の感染性リンパ囊腫を契機とした腸腰筋膿瘍

Iliopsoas abscess triggered by infected lymphocele after laparoscopic radical prostatectomy

　75歳，男性．前立腺癌に対し腹腔鏡下前立腺全摘除術，両側閉鎖リンパ節郭清術を施行した．経過に問題なく，術後8日目に退院した．術後3か月目に左大腿痛，歩行困難を主訴に近医整形外科を受診，MRIにて腸腰筋膿瘍が疑われ，当科紹介となった．造影CTにて感染性リンパ囊腫から波及した腸腰筋膿瘍と診断，抗菌薬加療を開始し，リンパ囊腫に対しドレナージを施行した．腸腰筋膿瘍の改善乏しくドレナージを追加．その後経過は順調であり，加療42日に後遺症なく軽快した．

Abstract

The patient was a 75-year-old man. A laparoscopic radical prostatectomy and bilateral obturator lymphadenectomy for prostate cancer was performed. He was discharged on the 8th postoperative day without any problems. Three months after surgery, he visited his local orthopedic surgeon with a chief complaint of left thigh pain and difficulty walking. He was referred to our department because of a suspected iliopsoas abscess on MRI. He was diagnosed as an iliopsoas muscle abscess spreading from infected lymphocele by contrast-enhanced CT. He was treated with antibiotics and drainage was performed for the lymphocele. Since the iliopsoas abscess did not improve, additional drainage was performed. His progress was good, and after 42 days of treatment, the disease resolved without sequelae (Rinsho Hinyokika 79 : 183-186, 2025).