虫垂炎術後に併発した悪性症候群の1例 A CASE REPORT OF NEUROLEPTIC MALIGNANT SYNDROME FOLLOWING AN OPERATION FOR ACUTE APPENDICITIS

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症例は41歳男性,精神発育遅滞・聾唖にて精神病院に長期間入院していた.右下腹部痛と発熱を来し前医にて腰椎麻酔下に虫垂切除術を受け,手術所見では壊疽性虫垂炎と盲腸周囲膿瘍形成を認めた.術後4日目頃より40°Cの稽留熱を認め,四肢筋のfasciculation・硬直や意識障害も出現し当院へ転院した.熱源として腹腔内遺残膿瘍を疑い試験開腹術を施行したが,麻痺性イレウスの所見のみで膿瘍は認めなかった.術翌日心停止を来し死亡した.その後,前々医にて軽躁状態と診断され抗精神病薬が長期投与されていたことを確認し,臨床経過,診断基準と併せて悪性症候群と診断した.本例では虫垂炎による発熱を認め,術後の高熱を遺残膿瘍によるものと考えた点,精神発育遅滞・聾唖のため意識障害や腹部所見の評価が困難であった点,抗精神病薬の投与を確認しなかった(精神病とは診断されていなかった)ことから,悪性症候群の診断が遅れ結果的に救命し得なかった.

A 41-year-old man with mental retardation, deaf and dumb underwent appendectomy under spinal anesthesia for gangrenous appendictis with ileocecal abscess at elsewhere. On the 4th postoperative day, intractable high fever, coma, fasciculation and rigidity on the extrimities developed and rapidly progressed. The patient was transferred to the hospital. We suspected an intraabdominal remnant abscess, but exploratory laparotomy under general anesthesia revealed no evidence of remnant abscess. A lumber puncture also yielded no abnormal findings of cerebrospinal fluid. He died of sudden cardiac arrest on the next day after the second operation. It was found postoperatively that he had been treated with neuroleptic drugs for a long period at slightly manic state, and he was diagnosed as neuroleptic malignant syndrome according to his clinical course and its diagnostic criteria. In this case we failed to make the correct diagnosis preoperatively, because postoperative high fever was considered due to remnant abscess; we had difficulty in evaluation of coma and abdominal symptoms for his mental retardation, deaf and dumb; and we did not confirm his former treatment with neuroleptic drugs (and he had not been diagnosed as psychosis).

収録刊行物

  • 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society

    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 56(3), 645-649, 1995-03-25

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10008512588
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    03869776
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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