原発性腹壁膿瘍の1例  [in Japanese] A CASE OF PRIMARY ABSCESS OF THE ABDOMINAL WALL  [in Japanese]

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Abstract

症例は50歳,男性で, 40歳時よりアルコール性高度肝機能障害を指摘されていた.上腹部痛を主訴に来院.腹部膨隆と臍上部皮膚の発赤,腫脹および同部の圧痛と筋性防御を認めた.血液検査上強い炎症反応を認め,腹部CT検査では左腹直筋内にlow densityを呈する腫瘤を,さらに同部に一致した皮膚の膨隆と病変の腹腔内への連続性を認めた.急性腹症として緊急開腹手術施行,腹部正中切開としたが開腹前に大量の膿汁流出を認めた.左腹直筋内に膿の貯留を認め,腹直筋後鞘を貫き腹腔内へも膿の波及がみられた.腹腔内は肝硬変を除き異常所見みられず,原発性腹壁膿瘍と診断した.手術は洗浄ドレナージとし,術後経過は良好であった.腹壁膿瘍は続発性のことが多く,原発性の報告例は自験例を含めて3例のみである.自験例においてはアルコール性の肝硬変による生体防御機構の低下が発症の成因に関与したものと推察された.

A 50-year-old man who had been pointed out severe alcoholic hepatic impairment since the age of 40 was admitted to the hospital because of upper abdominal distension and pain. Abdominal inspection showed a protruding mass with the reddish skin. There were tenderness and muscle guarding.<br> Abdominal US and CTscan revealed an abscess formation in the left abdominal wall and a contiguous mass in the peritoneal cavity.<br> Emergency operation was performed under a suspicion of colonic cancer or abscess of the peritoneal cavity invading the abdominal wall. Approximately 400ml of pus was discharged from the abscess of abdominal wall prior to laparotomy. There were no abnormal findings in the peritoneal cavity except liver cirrhosis. Primary abscess of the abdominal wall was diagnosed.<br> Most abscess of the abdominal wall are secondary, and there have been only three cases of primary abscess in the Japanese literature. In this case, we surmised that the abscess was caused by a decline of the host defense system due to alcoholic liver cirrhosis.

Journal

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

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 63(3), 728-731, 2002-03-25

    Japan Surgical Association

References:  24

Cited by:  2

Codes

  • NII Article ID (NAID)
    10008617333
  • 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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