腸管の微小穿孔による腹膜炎が疑われた回腸子宮内膜症の1例  [in Japanese] A Rare Case of Peritonitis with Intestinal Perforation Caused by Intestinal Endometriosis of the Terminal Ileum  [in Japanese]

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Author(s)

    • 中村 聡 Nakamura So
    • 九州大学医学研究院臨床・腫瘍外科 Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
    • 永吉 絹子 Nagayoshi Kinuko
    • 九州大学医学研究院臨床・腫瘍外科 Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
    • 貞苅 良彦 Sadakari Yoshihiko
    • 九州大学医学研究院臨床・腫瘍外科 Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
    • 藤田 逸人 Fujita Hayato
    • 九州大学医学研究院臨床・腫瘍外科 Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
    • 真鍋 達也 Manabe Tatsuya
    • 九州大学医学研究院臨床・腫瘍外科 Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
    • 中村 雅史 Nakamura Masafumi
    • 九州大学医学研究院臨床・腫瘍外科 Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University

Abstract

<p>症例は31歳,女性。下腹部痛を主訴に近医で入院加療されていたが,改善しなかったため精査・加療目的に翌日当院へ転院となった。転院時の腹部造影CTで,終末回腸の壁肥厚と周囲脂肪組織混濁を認めた。保存的加療では軽快せず,2日後の腹部造影CTで終末回腸周囲に遊離ガスを伴う液体貯留を認めたため,回腸穿孔による腹腔内膿瘍と診断し同日緊急手術を施行した。腹腔鏡下に観察すると,骨盤内に混濁した腹水と小腸・子宮・付属器に膿苔の付着を認めた。終末回腸は一塊となり炎症性腫瘤を形成していた。癒着を剥離し回盲部を授動した後に,小開腹創より回盲部を腹腔外に挙上し,一塊となった終末回腸を摘出した。病理組織検査では,腸管壁全層に内膜症病変を認め,穿孔の原因と思われた。腸管子宮内膜症の穿孔例はまれではあるが,基礎疾患のない若年女性の急性腹症では腸管子宮内膜症も鑑別疾患の一つとして考慮し診療を行うべきであると考えられた。</p>

<p>We report a rare case of intestinal perforation and abscess formation caused by ileal endometriosis. A 31-year-old woman was admitted to our hospital with a chief complaint of lower abdominal pain. An abdominal enhanced computed tomography showed wall thickness of the terminal ileum and abscess formation with free air. Upon laparoscopy, a clustered construction construction of the terminal ileum was found. Partial resection of the terminal ileum with an ileoileostomy was performed. The resected specimen revealed extensive endometriosis throughout the entire thickened bowel wall, suggesting micro-perforation of the ileal endometriosis. The postoperative course was uneventful. Perforation associated with intestinal endometriosis is a rare but important differential diagnosis of acute abdomen in young women.</p>

Journal

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

    Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) 37(5), 813-817, 2017

    Japanese Society for Abdominal Emergency Medicine

Codes

  • NII Article ID (NAID)
    130006243196
  • Text Lang
    JPN
  • ISSN
    1340-2242
  • Data Source
    J-STAGE 
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