直腸切断術後に発症したMRSA腸腰筋膿瘍の1例 A Case of MRSA Psoas Abscess after Amputation of the Rectum

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Author(s)

    • 齊藤 修治 SAITO S.
    • 横浜市立大学医学部第2外科 Second Department of Surgery, Yokohama City University, School of Medicine
    • 山口 茂樹 YAMAGUCHI S.
    • 横浜市立大学医学部第2外科 Second Department of Surgery, Yokohama City University, School of Medicine
    • 山岸 茂 YAMAGISHI S.
    • 横浜市立大学医学部第2外科 Second Department of Surgery, Yokohama City University, School of Medicine
    • 木村 英明 KIMURA H.
    • 横浜市立大学医学部第2外科 Second Department of Surgery, Yokohama City University, School of Medicine
    • 市川 靖史 ICHIKAWA Y.
    • 横浜市立大学医学部第2外科 Second Department of Surgery, Yokohama City University, School of Medicine
    • 遠藤 格 ENDO I.
    • 横浜市立大学医学部第2外科 Second Department of Surgery, Yokohama City University, School of Medicine
    • 関戸 仁 SEKIDO H.
    • 横浜市立大学医学部第2外科 Second Department of Surgery, Yokohama City University, School of Medicine
    • 渡会 伸治 TOGO S.
    • 横浜市立大学医学部第2外科 Second Department of Surgery, Yokohama City University, School of Medicine
    • 嶋田 紘 SHIMADA H.
    • 横浜市立大学医学部第2外科 Second Department of Surgery, Yokohama City University, School of Medicine

Abstract

症例は65歳男性.直腸癌(P-Rb)の診断で腹仙骨腹式直腸切断術,D3リンパ節郭清,骨盤内臓神経両側部分温存術を施行した.術後に会陰皮下膿瘍を合併し,培養でMSSAとEnterococcus faecatisが検出されたが抗生剤投与と洗浄で軽快,術後31日目に退院した.術後72日目から発熱と大腿部痛が出現し再入院となった.入院時には左腰部の叩打痛と左腸腰筋肢位を認めた.腹部CTにて左腸腰筋から骨盤内に連続する膿瘍陰影があったため,抗生剤投与を開始すると共に,超音波ガイド下にドレナージチューブを挿入した.膿汁培養でMRSAが検出されたため抗生剤をTeicoplaninへ変更し,チューブ洗浄を続けることにより腸腰筋膿瘍は軽快した.膿瘍発生機序は,腹膜外経路で閉鎖腔に留置した開放式ドレーンの逆行性感染により閉鎖腔から腸腰筋前面に感染したものと考えられた.予防には閉鎖式ドレーンの使用が,治療には超音波ガイド下のドレナージが有用と思われた.

A 65-year-old man underwent abdomino-sacro-abdominal resection of the rectum, with extended lymph node dissection and bilateral partial autonomic nerve preservation, for an advanced lower rectal cancer. After the operation, transient perineal wound infection was seen, with MSSA and Enterococcus faecalis. He was readmitted to our department due to high-grade fever and thigh pain, on the 79th postoperative day. He had knocking pain in the left lower back, and his left hip was kept in flexion with limitation of extension. Because left psoas abscess was diagnosed by abdominal and pelvic CT, IPM/CS and CLDM were given by i.v. drip infusion. Ultrasonography-guided percutaneous catheter drainage was performed to the psoas abscess, and MRSA was detected from the purulent collection. After drainage and appropriate antibiotic therapy using TEIC, the symptoms improved and the abscess disappeared. In this case, the cause of the psoas infection was thought to have been as follows : The obturator fossa became infected by retrograde of the open drain, which was inserted from the mid-line incision, and the infection spread to the psoas muscle. Ultrasonography-guided percutanesous catheter drainage can be a useful treatment for psoas abscess.

Journal

  • Nippon Daicho Komonbyo Gakkai Zasshi

    Nippon Daicho Komonbyo Gakkai Zasshi 55(6), 302-306, 2002-06-01

    The Japan Society of Coloproctology

References:  8

Cited by:  1

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