腹腔鏡補助下に切除しえた魚骨とPTPによる小腸穿孔の2例―術前MDCT画像の有用性―

Perforation of the digestive tract caused by a fish bone and a press through package treated by laparoscopic surgery : effectiveness of the preoperative multi detector CT image

◆要旨：消化管異物はほとんどが消化されるか，自然に排泄される．しかし稀に消化管穿孔・穿通をきたし，外科的手術を余儀なくされる症例がある．今回筆者らは魚骨とpress through package （以下，PTP）による腸管穿孔に伴う急性限局性腹膜炎の2例を経験したので報告する．2例とも男性で，腹痛を主訴に来院した．入院後精査の腹部CT検査で症例1は魚骨による腸管穿孔，症例2はPTPによる腸管穿孔と診断し，いずれも腹腔鏡補助下小腸部分切除術を施行した．急性腹症の鑑別診断として，多彩な臨床症状を呈する消化管異物による腹膜炎も選択肢の1つであり，炎症が軽微な症例では低侵襲な腹腔鏡下手術も可能と考えられた．

　Perforation of the digestive tract caused by a foreign body is rare since the foreign body usually pass spontaneously without complications. When it occurs, surgical removal is necessary to remove foreign bodies. We report two cases of perforation of the digestive tract with acute local peritonitis caused by a fish bone and a press through package. Two men were admitted to our hospital due to abdominal pain. Abdominal CT scan showed perforation of the digestive tract caused by a fish bone and a press through package. Two foreign bodies were removed by laparoscopy-assisted partial resection of the small intestine. Peritonitis caused by a foreign body in the digestive tract with various clinical symptoms is an option as differential diagnosis of acute abdomen. Minimally invasive laparoscopic surgery could be useful in our cases.