完全腹腔鏡下に手術しえた自転車ハンドル外傷による十二指腸穿孔の1例

Laparoscopic surgery for traumatic perforation of the duodenum by bicycle handlebar injury : A case report

◆要旨：患者は19歳，女性．自転車走行中に転倒しハンドルで左上腹部を強打した．帰宅後腹痛の増悪があり，救急要請した．来院時理学的所見では臍中心に圧痛を認めたが，腹膜刺激症状は認めなかった．腹部単純CT検査でも異常所見を認めず，帰宅のうえ経過観察となったが，受傷翌日に腹痛が増悪し再度当院を受診した．腹部造影CT検査にて腹腔内遊離ガスを認め，外傷性消化管穿孔と診断し，腹腔鏡下手術を施行した．十二指腸上行脚に2cmの穿孔部を認め，完全腹腔鏡下に全層連続縫合閉鎖した．術後経過は良好で，術後第5病日より経口摂取を開始し，第12病日に退院となった．外傷性消化管穿孔に対する完全腹腔鏡下手術は1つの選択肢となりうることが示唆された．

　A 19-year-old woman was delivered to the emergency department with moderate abdominal pain after a fall onto a bicycle's handlebar from a standing position. Physical findings showed tenderness around the navel, but no peritoneal irradiation sign was observed. No abnormalities were found by computed tomography （CT）. The patient returned to our hospital the next day due to exacerbation of the abdominal pain. Abdominal CT detected wall thickening of the small intestine, fluid collection and free gas. Laparoscopic surgery was performed 17 hours after the accident. A 2-cm perforation in the duodenum at the posterior wall of the 4th portion was confirmed. Simple sutures of the ruptured bowel were performed laparoscopically. There were no postoperative complications ; the patient started oral ingestion from the 5th postoperative day and was discharged on the 12th postoperative day. For traumatic duodenal perforation, total laparoscopic surgery was useful when the damage was mild.