腹腔鏡下手術が有用であった小児外傷性小腸穿孔の1例

Laparoscopic assisted surgery for a blunt abdominal trauma with small bowel injury in a 6-year-old child : a case report

◆要旨：患者は6歳，男児．9歳の姉に腹部を蹴られ腹痛と嘔吐を主訴として来院した．腹膜刺激症状は明らかでなかったが，腹部に圧痛があり下腹部には軽度の抵抗を認めた．腹部CTにて腹腔内遊離ガス像は認めなかったが小腸の肥厚と腹水貯留を認めた．入院のうえ経過観察したが状態の改善がなく，腹腔内精査のために腹腔鏡下手術を施行した．腹腔内には中等量の血性腹水の貯留と小腸に5mm大の穿孔を認めた．ポート挿入口を切開延長し，体外操作にて穿孔部を縫合閉鎖し術後は順調に経過した．循環動態の安定した腹部鈍的外傷では小児においても腹腔鏡下手術は有用であると思われた．

　A 6-year-old boy was admitted to our hospital with a chief complaint of abdominal pain and vomiting after a fight where he recieved a kick in the abdomen from his 9-year-old sister. Although we found no apparent muscular guarding, there was a tenderness and slight resistance in the lower abdomen. Abdominal CT detected wall thickening of small intestine and fluid collection, but no apparent pneumoperitoneum. Since he did not recover after a short period of observation, laparoscopic surgery was undertaken to explore the abdomen. Some amount of hemorrhagic ascites and 5-mm perforation on the small intestine were found. The port site was extended and the injured bowel was exteriorized to repair the perforation without any postoperative complication. Laparoscopic surgery was supposed to be useful for hemodynamically stable pediatric patients with blunt abdominal trauma.