腹腔鏡下手術が有用であった魚骨穿通による回腸炎症性肉芽腫の1例

Granulomatous inflammation of the ileum caused by a fish bone and successfully treated by laparoscopic surgery

◆要旨：患者は36歳，男性．2010年1月中旬，鮭を摂取し，4日後より右下腹部痛が出現した．近医にて抗生物質加療を受けたが改善に乏しく，当院に紹介となった．腹部造影CT検査にて回腸末端周囲に直径約4cmの膿瘍を疑う低濃度領域を認め，回腸末端炎，腹腔内膿瘍の疑いで入院・加療となった．抗生物質投与で炎症反応，腹痛は軽快したが，CT検査上，低濃度領域が残存していたため，腹腔鏡下手術を施行した．回腸が炎症性に一塊となっており，回腸部分切除術を行った．切除標本では膿瘍内に魚骨が存在しており，魚骨回腸穿通，腹腔内膿瘍と診断した．病理組織学的検査で慢性炎症性肉芽腫と診断された．術後経過は良好で術後8日目に退院となった．

　A 36-year-old man presented with abdominal pain in the lower right quadrant for four days with slight fever. He had received antibiotic drugs therapy for 4 days in another hospital since the onset of abdominal complaint, but no improvement was noticed. An abdominal enhanced CT scan on admission revealed ileocecal wall thickening and abscess formation measuring 4 cm in diameter. No foreign body was delineated by CT scan. Diagnosis of inflammation of the terminal ileum with abscess formation was made and antibiotic drugs therapy continued without any improvement. 　Laparoscopic observation and surgery was then chosen. Inflammation was present in the terminal ileum and local ileum resection was performed. A foreign body that appeared to be a fish bone was present in the resected specimen, and this led to the diagnosis of granulomatous inflammation of the ileum caused by a fish bone. The patient was discharged on the 8th postoperative day without complications.