魚骨の胃穿通に対して腹腔鏡下異物除去術を施行した1例

Laparoscopic removal of a fish bone peneterating through stomach : a case report

症例は54歳，男性．心窩部痛，熱発にて当院を受診した．CTにて胃と肝臓の間に長さ約3cmの線状異物，肝外側区域および胃壁内に膿瘍を認めた．上部消化管内視鏡では胃幽門前庭部小彎側前壁に隆起を認めるのみであった．超音波下肝膿瘍穿刺ドレナージを施行し，膿瘍は縮小したものの炎症が消失せず，腹腔鏡下に異物除去術を施行した．異物は魚骨であった．術後肝膿瘍は消失し，経過は良好であった．魚骨の胃穿通による肝膿瘍の報告は少なく，腹腔鏡下に摘出した症例は本例が2例目である．腹腔鏡下手術は低侵襲であり拡大視が可能であるため，本例における異物除去には有効であった．

　54-year-old male patient came to the hospital with the chief complaint of epigastralgia and high fever. Abdominal CT scan revealed linear foreign body between the stomach and the liver, and liver abscess in the lateral segment. Upper gastrointestinal endoscopy showed only an elevated lesion in the antrum of stomach but no change in the mucosa. Percutaneous trans-hepatic drainage of the liver abscess was performed under ultrasonographic guidance. The size of the abscess was reduced but inflammation persisted. To remove the foreign body, laparoscopy-assisted surgery was performed. The foreign body was revealed to be a piece of fish bone. Postoperative course was good and the liver abscess disappeared. Review of the literature revealed only few cases of liver abscess induced by fish bone penetration through the stomach. This is the second reported case of a patient who was is treated by laparoscopic procedure. Because laparoscopic surgery is less invasive and provides magnified view, it was useful to remove the foreign body in this case.