上部空腸憩室穿孔による汎発性腹膜炎の1例  [in Japanese] Peritonitis Caused by Perforation of a Jejunal Diverticulum:A Case Report  [in Japanese]

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Abstract

<p>症例は65歳女性。主訴は腹痛。腹部単純X線写真でfree airを認め,腹部CT検査を施行し,汎発性腹膜炎の診断で当院へ搬送となった。身体所見では左下腹部を中心とした圧痛・反跳痛を認めた。血液・生化学所見では,WBC 4,700/μL,CRP 37.21mg/dLで炎症反応高値であった。腹部CT検査では上部空腸に穿孔を認め,周囲にfree air,腹水を認め,上部空腸穿孔による急性汎発性腹膜炎の術前診断で緊急手術を施行した。術中所見ではTreitz靭帯より肛門側へ10cmの空腸腸間膜側に穿孔を認め,空腸部分切除,十二指腸空腸吻合術(側々吻合)を施行した。摘出標本では明らかな腫瘍性病変はなく,憩室穿孔が原因と考えられ,病理では,仮性憩室穿孔の診断であった。上部空腸憩室穿孔はまれな疾患であるが,消化管穿孔の鑑別診断として考慮する必要のある疾患である。</p>

<p>A 65-year-old woman visited another hospital with a history of abdominal pain. As a plain abdominal X-ray showed free air in the abdomen and abdominal CT scan showed evidence of perforation and peritonitis, the patient was transferred to our hospital for emergency operation. Physical examination revealed tenderness in the left lower quadrant. Laboratory data were consistent with an inflammatory process;the white blood cell count was 4,700/μL and the serum C-reactive protein level was 37.21mg/dL. Abdominal CT showed perforation of the proximal jejunum, with free air and a fluid collection around the perforation. We performed emergency laparotomy for proximal jejunal perforation. Intraoperatively, the jejunal perforation was seen 10 cm distal to the ligament of Treitz. We performed jejunal resection with duodeno-jejunal anastomosis (side-to-side) for reconstruction. The histopathological diagnosis was perforation of a pseudo-diverticulum in the proximal jejunum. The patient's postoperative course was uneventful.</p>

Journal

  • Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine)

    Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) 37(1), 085-089, 2017

    Japanese Society for Abdominal Emergency Medicine

Codes

  • NII Article ID (NAID)
    130005540270
  • Text Lang
    JPN
  • ISSN
    1340-2242
  • Data Source
    J-STAGE 
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