孤立性脾膿瘍に対しエコーガイド下ドレナージが有効であった1例  [in Japanese] SUCCESSFUL ECHO-GUIDED DRAINAGE FOR SOLITARY SPLENIC ABSCESS-A CASE REPORT-  [in Japanese]

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Abstract

脾膿瘍は比較的稀な疾患であるが,抗生物質の発達や,抗癌剤化学療法の普及,画像診断技術の進歩に伴い報告例は増加している.今回,イレウス解除術後の孤立性脾膿瘍に対し,エコーガイド下穿刺ドレナージが有効であった症例を経験したので報告する.患者は69歳の男性で,早期胃癌で幽門側胃切除術後3カ月目にイレウスの診断で再入院,イレウス解除術を受けた.術後15日目に発熱し,超音波・CT検査で脾膿瘍と診断された.エコーガイド下に穿刺ドレナージを行い治癒せしめた.脾臓摘出術は,術後の免疫能の低下が明らかとなっており,孤立性脾膿瘍に対しては,エコーガイド下穿刺ドレナージが第一選択であると考える.

Splenic abscess is relatively uncommon, however, it has been increasingly diagnosed with an increase in the number of compromised hosts and with a widespreading use of more sophisticated medical imaging techniques. This paper presents a case of solitary abscess after operative ileus resolution in which echoguided needle drainage was effective. A 69-year-old man undergone a distal gastrectomy for early gastric cancer three months before was admitted to the hospital because of abdominal pain. He was diagnosed as having intestinal obstruction caused by adhesion. Conservative therapy was unsuccessful. A laparoscopic adhesiotomy was performed initially, but the small intestine was injured, therefore, we converted to an open laparotomy to perform lysis of the adhesion and a partial excision of the injured intestine. Fifteen days later he had a high fever. Computed tomography and ultrasonography demonstrated a cystic mass in the spleen. Under a diagnosis of splenic abscess, ech-oguided needle drainage was performed. Bacteroides fragilis was cultured in the pus. He recovered 28 days later. Percutaneous drainage for solitary splenic abscess is a safe and effective approach to conserve the spleen, that has a great value immunologically because immunosuppression after splenectomy for splenic abscess has been clarified.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 62(3), 800-803, 2001-03-25

    Japan Surgical Association

References:  13

Cited by:  1

Codes

  • NII Article ID (NAID)
    10008389138
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13452843
  • Data Source
    CJP  CJPref  J-STAGE 
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