クラミジア感染による肝周囲炎(Fitz-Hugh-Curtis症候群)が原因と考えられるイレウスの1手術例 A Operated Case of Ileus Caused by Perihepatitis (Fitz-Hugh-Curtis Syndrome) Supposedly due to Chlamydia Trachomatis Infection

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症例は41歳の女性. 手術歴はない. 平成3年と5年に下腹部痛で当院を受診. 平成11年11月7日夕方突然間欠的な右季肋部痛が出現, 次第に増強して当院内科を受診した. 右上腹部に強い圧痛を認め腸音は亢進していたが, 反跳痛や筋性防御はなく, 白血球数, CRP値も正常であった. 腹部X線写真, およびCTで肝前面の横隔膜下に鏡面像を伴った小腸の拡張を認めた. 踵吐も出現し, イレウスの診断音で内ヘルニアを疑い緊急手術を施行. 肝と腹壁の間にviolin string状の検状物を伴つた著明な線維性癖着を認め, その間に小腸が入り込んでいた. 小腸を引き出し線維性癒着を切除してイレウス解除できた, 子宮附属器に軽度の炎症像を認め, 術後の採血でクラミジアIgA抗体は1.38, TgG抗体は5.41と陽性でクラミジア感染による肝周囲炎が原因のイレウスと考え報告した.

A 41-year-old female with no surgical history was treated at our hospital in 1991 and 1993 for lower abdominal pain. When intermitent hypochondrial abdominal pain suddenly occurred on the evening of November 7, 1999, and gradually increased, she visited our department of internal medicine. Marked tenderness in the hypochondrial abdomen and increased bowel sounds were noted, but she did not exhibit rebound tenderness or muscular defense. White blood count and C-reactive protein were within normal limits. Radiography and computed tomography (CT) of the abdomen revealed a dilated small intestine with air-fluid under the diaphragm on the anterior surface of the liver. After vomiting, and a diagnosis of ileus, a nasogastric tube inserted and the woman was hospitalized. Since abdominal pain persisted despite analgesics, she was referred to the department of surgery. Due to tympanism and metallic bowel sounds in the abdomen, emergency surgery was conducted for suspected internal hernia. Marked fibrous adhesion between the liver and abdominal wall with violin string, like funicular substances enclosing the small intestine existed was observed. The small intestine was retracted and the fibrous adhesion resected, curing of the ileus. Slight inflammation in the uterine appendages was noted, and a postoperative blood sample was positive for chlamydia TgA antibody 1.38 and IgG antibody 5.41. Based on intraoperative findings, we diagnosed ileus caused by perihepatitis apparently due to chlamydia trachomatis infection.

収録刊行物

  • 日本消化器外科学会雑誌

    日本消化器外科学会雑誌 34(8), 1331-1335, 2001-08-01

    一般社団法人日本消化器外科学会

参考文献:  19件中 1-19件 を表示

被引用文献:  8件中 1-8件 を表示

各種コード

  • NII論文ID(NAID)
    110001343945
  • NII書誌ID(NCID)
    AN00192066
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    03869768
  • データ提供元
    CJP書誌  CJP引用  NII-ELS 
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