上行結腸部で後腹膜腔穿孔を来した横行結腸癌の1例  [in Japanese] A CASE OF RETROPERITONEAL ABSCESS DUE TO ORAL PERFORATION OF A CANCER OF THE TRANSVERSE COLON  [in Japanese]

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Abstract

症例は78歳男性.急激な下腹部痛を主訴に当科救急受診.腹部X線写真で右腎周囲の気腫像,腹部CTで横行,上行結腸の拡張,右腎周囲のガス像が認められた.上行結腸後腹膜腔穿孔と診断し,発症3時間後緊急手術を施行した.手術所見では,横行結腸脾彎曲側1/3に6×6cm,肉眼的深達度SSの癌腫が存在し,それより40cm口側,上行結腸に6×3cmの穿孔を認めた.穿孔部は周囲脂肪織に被覆され,糞便性腹膜炎を合併していなかった.手術は結腸右半切除術および後腹膜腔洗浄ドレナージ術を施行し救命した.本邦における上行結腸後腹膜腔穿孔例は自験例を含め22例で, 90年代の報告例6例のうち5例が救命されている.本例のように後腹膜腔穿孔例は,穿孔様式が被覆穿孔であり糞便性腹膜炎を合併しておらず,術前ショック状態を合併していなければ救命しえる急性腹症と思われる.

A 78-year-old man was admitted to the hospital because of hypogastric pain. Abdominal X-ray film and computed tomography revealed retroperitoneal gas. Retroperitoneal perforation of the ascending colon was suspected, and an emergency operation was performed 3 hours after the onset of symptoms. No gross fecal soiling of the peritoneal cavity could be detected, since an abscess dur to the oral perforation of a cancer of the transverse colon was covered by the retroperitoneal adipose tissue.<br> Abscess drainage with right hemicolectomy was performed. So far 22 cases of retroperitoneal perforation of the ascending colon have been reported, and five out of six patients reported in 1990's were successfully saved. The prognosis of retroperitoneal abscess due to colonic perforation is better than that of colonic perforation into the free peritoneal cavity, so without septic shock, active curative treatment should be performed.

Journal

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

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 59(4), 1047-1050, 1998-04-25

    Japan Surgical Association

References:  22

Cited by:  2

Codes

  • NII Article ID (NAID)
    10008435911
  • 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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