右卵巣に穿通し卵巣膿瘍を形成した虫垂炎に対し腹腔鏡下手術で治癒しえた1例

A case of appendicitis with ovarian abscess resected by laparoscopic surgery

◆要旨：患者は19歳，女性．骨盤内膿瘍に対して抗菌薬投与で炎症が改善し退院したが，後日CTで膿瘍は残存し，虫垂腫大と糞石を指摘され，虫垂炎も疑われ当科を併診した．穿孔性虫垂炎，腹腔内膿瘍と診断し腹腔鏡下に手術を施行した．虫垂腫大は軽度であったが，虫垂先端が右卵巣に癒着し右卵巣腫大を認めた．卵巣被膜を切開すると排膿を認め，繰り返す虫垂炎が卵巣に穿通し，膿瘍形成したと考えられた．卵巣内部を洗浄ドレナージし，虫垂切除を施行した．合併症なく退院した．術後2年6か月現在，膿瘍再発はない．卵巣膿瘍の多くは上行性感染が原因で，虫垂炎が原因のことは稀である．今回，腹腔鏡下手術で治癒しえた1例を経験したので文献的考察を踏まえて報告する．

　We report a case of an ovarian abscess that was associated with appendicitis. A 19-year-old woman with lower abdominal pain visited our hospital. CT showed pelvic polycystic abscess. After conservative treatment with antibiotics, the abscess remained. Then, laparoscopic surgery was performed urgently under the preoperative diagnosis of perforated appendicitis with intraabdominal abscess. Intraoperatively, the right ovary was swelling with abscess and adhered to the appendix. The findings suggested that the appendicitis penetrated into the right ovary, so the capsule of the ovary was opened for drainage and appendectomy was performed. The patient was discharged with no complication and has no recurrence of the abscess. There have been only few reported cases of appendicitis with ovarian abscess treated by laparoscopic surgery.