磁石玩具誤飲による盲腸・小腸穿孔に対して腹腔鏡下手術を施行した1例

Laparoscopic surgery performed in a case of perforation of the cecum and small intestine due to accidental ingestion of magnet toys : A case report

◆要旨：症例は7歳9か月の男児．腹痛を主訴に救急外来を受診し，腹部単純X線検査にて右下腹部に小球型の異物陰影を複数個認め，前日に使用した磁石玩具と考えられた．腹部造影CT検査ではfree airは認めなかったが，骨盤底に腹水の貯留を認めた．アーチファクトにより磁石玩具が同一腸管内に存在するかは判断できず，緊急で臍部からの単孔式腹腔鏡下手術を施行した．小腸と盲腸が腸管壁越しに吸着しており，吸着部分には穿孔所見を認めたため，磁石を摘出し，縫合閉鎖および虫垂切除術を施行した．術後7日目に退院となった．複数個の磁石誤飲は，磁石同士の吸着により穿孔を生じる場合があり，早期の手術を検討する必要がある．

　A seven-year-old boy came to the emergency department with a chief complaint of abdominal pain. Abdominal X-ray imaging revealed multiple foreign body shadows in the lower right abdomen. It turned out the patient had accidentally swallowed a magnetic toy the day before. Abdominal computed tomography showed no free air, but ascites was observed in the Douglas'pouch. Artifacts made it difficult to determine whether or not the magnet toy was in the same intestinal tract. Although his abdominal pain showed an improving trend, the toy had not moved after three hours. Emergency surgery was therefore performed by single-incision laparoscopy. The small intestine and cecum were retracted over the wall, and the intestinal wall was found to have become perforated. The appendix was resected by extracorporeal operation, and the magnet toy was removed from the appendix root. The postoperative course was uneventful, and the patient was discharged on the seventh day after surgery. Accidental ingestion of multiple magnets may cause bowel perforation due to the magnets sticking together, so early surgery should be considered.