腹腔鏡手術が有用であった穿孔部が自然閉鎖した鶏骨による胃穿孔の1例

A case of gastric perforation caused by an ingested chicken bone with spontaneous closure of the perforation site treated by laparoscopic surgery

◆要旨：症例は51歳，女性．2日前に鶏の丸焼きに混入した鶏骨を誤飲し上腹部痛を主訴に当院を受診した．腹部CTで腹腔内に線状のhigh densityな構造物を認め，上部消化管内視鏡で胃前庭部小彎前壁に潰瘍を認めた．以上より異物による胃穿孔と診断し緊急手術を施行した．腹腔鏡観察にて胃前庭部小彎前壁の漿膜に発赤と陥凹を認めたが穿孔部はすでに自然閉鎖していた．小網前面に鶏骨を認めたため腹腔鏡下に摘出し，穿孔部に漿膜筋層縫合を加え補強した．術後経過良好で術後4病日に退院した．穿孔部が自然閉鎖した鶏骨による胃穿孔に対し，腹腔鏡下に異物を摘出した手術症例を経験したため報告する．

　Most of ingested gastrointestinal foreign bodies are naturally excreted without complications ; however, they sometimes cause intestinal perforation that requires operation. We report a patient with gastric perforation who underwent laparoscopic surgery for removing an ingested chicken bone. A 51-year-old woman presented to our hospital with upper abdominal pain. Abdominal CT revealed a linear high-density structure in the abdominal cavity, and upper gastrointestinal endoscopy showed an ulcer on the anterior wall of the lesser curvature of the gastric antrum. Based on these findings, gastric perforation caused by a foreign body was diagnosed, and emergent laparoscopic surgery was performed. Laparoscopic observation revealed redness and indentation of the serosa on the anterior wall of the lesser curvature of the gastric antrum, but the perforation site had already closed spontaneously. A chicken bone was found on the anterior surface of the omentum and was laparoscopically removed. Seromuscular suturing was added to reinforce the perforation site. The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day. We report a surgical case of gastric perforation caused by a chicken bone in which the perforation site had spontaneously closed, and the foreign body was successfully removed laparoscopically. In cases of gastric perforation caused by bone fragments, spontaneous closure without peritonitis may occur. Thus, laparoscopic approach, which is minimally invasive and allows for comprehensive inspection of the abdominal cavity, may be considered the first choice in such cases. Herein, we described an atypical case of gastric perforation with a review of the literature.