大腿神経麻痺をきたしたS状結腸憩室穿孔による後腹膜膿瘍の1例  [in Japanese] A CASE OF RETROPERITONEAL ABSCESS DUE TO PERFORATION OF THE SIGMOID COLON DIVERTICULUM CAUSING FEMORAL NEUROPATHY  [in Japanese]

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Abstract

大腿神経麻痺をきたしたS状結腸憩室穿孔による後腹膜膿瘍の稀な1例を経験したので報告する.症例は69歳,女性.主訴は,発熱,左側腹部痛,歩行障害.腹部CTにて,左骨盤側壁に径約4cm大でS状結腸に接し内部に液体と空気による鏡面を形成する嚢胞性腫瘤を認めた. S状結腸憩室穿孔にょる後腹膜膿瘍と診断し,緊急手術を施行した. S状結腸は骨盤左側壁と炎症性に癒着しており,周囲は著明に浮腫状であった. S状結腸を遊離すると多量の膿汁の流出を認めた. S状結腸切除術,ドレナージ術を施行した.なお,炎症が高度のためcovering colostomyを造設した.摘出標本でS状結腸憩室穿孔による後腹膜膿瘍と診断された.術後は,速やかに歩行障害は改善した.大腸憩室の後腹膜穿孔は比較的稀である.また,大腸穿孔による後腹膜膿瘍が大腿神経麻痺を合併した症例は,調べ得た範囲内で本邦2例目であった.

We report a rare case of retroperitoneal abscess due to perforation the sigmoid colon diverticulum with femoral neuropathy. A 69-year-old woman admitted for fever, abdominal pain, and difficulty in walking was found on abdominal CT scan to have a 4cm retroperitoneal abscess on the left side of the pelvis connected to the sigmoid colon. Emergency surgery based on a diagnosis of a retroperitoneal abscess caused by diverticulum perforation showed the sigmoid colon fixed to the retroperitoneum in the left pelvic space with inflammation and edema. When the sigmoid colon was mobilized anteriorly, a large amount of pus was found. Sigmoidectomy and drainage were done with a covering colostomy because of severe inflammation. The final diagnosis was retroperitoneal abscess caused by diverticulum perforation of the sigmoid colon. The postoperative course was uneventful. The patient could walk smoothly soon after surgery. Perforation of colon diverticula into the retroperitoneal space is thought to be relatively rare, especially retroperitoneal abscess from colon perforation with femoral neuropathy. Our case was the second such report, to our knowledge, in the Japanese literature.

Journal

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

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 63(3), 755-758, 2002-03-25

    Japan Surgical Association

References:  11

Cited by:  1

Codes

  • NII Article ID (NAID)
    10008617432
  • 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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