上部消化管造影検査後のバリウム糞石により大腸穿孔を起こした1例  [in Japanese] A Case of Colon Perforation Caused by Fecaloma of Barium after Upper Gastrointestinal Radiography  [in Japanese]

Access this Article

Search this Article

Author(s)

Abstract

症例は50歳,女性.検診で上部消化管造影検査施行後7日目に,急激な腹痛が出現した.前医に緊急入院となったが,排便なく,貧血の進行も認めたため,当院へ転院となった.腹部CT検査で,S状結腸周囲に腹腔内遊離ガス像と,腸管外へのバリウムの漏出を認めた.また,骨盤底には強いアーチファクトを引く巨大なバリウム陰影を認めた.下部消化管穿孔疑いにて,同日緊急手術を施行した.術中所見では,S状結腸の腸間膜側へ穿孔を起こしており,同部では壊死性の変化を伴っていた.また,直腸内には鶏卵大の硬い異物を触知した.ハルトマン手術,腹腔ドレナージを施行した.直腸内異物を用手的に肛門から排出させると,バリウム塊であった.標本上は,34mm大の穿孔部を認めた以外,憩室や腫瘍性病変は指摘できなかった.バリウムによる上部消化管造影検査後の大腸穿孔はまれであるが,重篤な転帰をとる場合もあるため,若干の文献的考察を加えて報告する.

A 50-year-old woman developed acute abdominal pain seven days after receiving upper gastrointestinal radiography. She was admitted to a different hospital, but later was transferred to our hospital because of suspension of defecation and progression of anemia. Abdominal computed tomography showed free air around the sigmoid colon and leakage of barium from the intestinal tract. It also showed a huge barium shadow with strong artifact in the pelvic floor. She was diagnosed with colon perforation and an emergency operation was performed. In the intraoperative findings, perforation occurred on the mesenteric side of the sigmoid colon with necrotic change. A hard foreign body the size of an egg was detected in the rectum. We performed Hartmann's operation and peritoneal drainage. The foreign body was extracted from the rectum, and was found to be fecaloma of barium. The resected specimen showed no diverticulum or neoplasm except for a clear hole 34mm in diameter. Colon perforation after upper gastrointestinal radiography is rare, but sometimes leads to a severe outcome. We report this case of colon perforation by fecaloma of barium with a review of the literature.

Journal

  • Nippon Daicho Komonbyo Gakkai Zasshi

    Nippon Daicho Komonbyo Gakkai Zasshi 69(7), 374-378, 2016

    The Japan Society of Coloproctology

Codes

Page Top