大腿骨頸部骨折で入院した高齢者に認められた特発性気腹症の1症例

A Case of Spontaneous Pneumoperitoneum in an Elderly Patient with Right Hip Fracture

要旨

　95歳の女性で，大腿骨頸部骨折の手術目的に搬送された。発熱の精査目的の腹部コンピュータ断層撮影（CT）検査で腹腔内遊離ガス像を認め，緊急手術を行ったが，消化管穿孔を認めず特発性気腹症と診断した。経過良好で，大腿骨頸部骨折の手術を行い，第28病日に転院した。特発性気腹症の認識と総合的な診断が，不必要な手術の回避に重要である。

　Pneumoperitoneum without gastrointestinal tract perforation is a rare clinical condition called spontaneous pneumoperitoneum. The author presents a case of spontaneous pneumoperitoneum in a 95-year-old female. She was admitted to our institution with right hip fracture. On the day of admission, she had fever and it was continuing for approximatoly. ten days. Abdominal computed tomography was performed, and a free air was found in the upper abdominal cavity. She did not complain of any abdominal pain, but emergency laparoscopic surgery was performed based on the possibility of gastrointestinal perforation. However, in the abdominal cavity, contaminated fluid collection and gastrointestinal tract perforation were not observed. She was thus diagnosed as spontaneous pneumoperitoneum. Her postoperative clinical course was satisfactory, and underwent the surgery for her right hip fracture on the 11^th postoperative day, and was discharged on the 28^th postoperative day. In the management of spontaneous pneumoperitoneum, recognition of this disease and an accurate diagnosis based on clinical symptoms and clinical imaging will contribute to avoid the unnecessary laparotomy.