大腿部膿瘍をきたした閉鎖孔ヘルニア嵌頓穿孔の1例 A CASE OF PERFORATION OF OBTURATOR HERNIA CAUSING ABSCESS OF THE THIGH

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症例は89歳,女性.右股関節痛および右大腿部に広範な皮下気腫を認め,ガス壊疽を疑われ当院内科紹介入院.入院時は両側胸水と小腸イレウスを認め,右鼠径部から大腿内側に腫脹,圧痛,握雪感を伴っていた.大腿部切開ドレナージで膿性浸出液を認め外科紹介となる.右大腿内側から下腿にかけての疾痛,しびれあり,閉鎖孔ヘルニア嵌頓穿孔による大腿部膿瘍と診断し,全身状態改善後開腹手術施行.回盲部より約100cm口側の回腸壁が右閉鎖孔に嵌頓し穿孔していたため,同部を切除側々吻合した.ヘルニア門は示指頭大で,大腿部膿瘍との交通を確認後縫合閉鎖した.術後86病日に軽快退院した.大腿部膿瘍の診断には,閉鎖孔ヘルニア嵌頓穿孔を疑う必要がある.また本症の外科的治療方針決定に際し,高齢,全身状態不良例が多いことから大腿部膿瘍ドレナージ先行による二期的手術が術後合併症も少なく安全と考えられた.

A case of obturator hernia originated from thigh abscess which is relatively rare is reported here.<br> An 89-year-old woman was admitted to the hospital because of right coxalgia and subcutaneous emphysema of the right thigh.<br> On hospitalization, she had poor general condition. With a suspicion of gas gangrene, she was under observation with right thigh drainage. When she was referred to the surgical clinic, a diagnosis of the right obturator hernia and perforation to the thigh was made based on Howship-Romberg sign. After her general condition was recovered, an operation was performed. At surgery, it was found that the ileum incarcerated into the right obturator hernia and perforated to the thigh. The ileum was resected about 20cm in length and the hernia hilum was closed with direct suture. The right thigh abscess was washed enough and inserted a drain tube. After the surgery, no complication occurred. The patient was discharged very much improved on 86th hospital day. It is essential to suspect perforation of obturator hernia when thigh abscess is encountered.<br> Most patients with perforated obturator hernia with thigh abscess are in poor general condition. Therefore, the operation of a two-step approach is recommended preceded by drainage of the abscess that is safe with minimal postoperative complications.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 62(10), 2547-2551, 2001-10-25

    Japan Surgical Association

参考文献:  19件中 1-19件 を表示

被引用文献:  5件中 1-5件 を表示

各種コード

  • NII論文ID(NAID)
    10008391067
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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