4 0 0 0 OA 爪楊枝の胃壁穿通による肝膿瘍の1例
- 著者
- 加藤 文崇 星野 宏光 山本 為義 小林 省吾 棟方 哲 大里 浩樹
- 出版者
- 日本臨床外科学会
- 雑誌
- 日本臨床外科学会雑誌 (ISSN:13452843)
- 巻号頁・発行日
- vol.77, no.8, pp.2022-2026, 2016 (Released:2017-02-28)
- 参考文献数
- 21
爪楊枝の胃壁穿通による肝膿瘍の1例を経験したので報告する.症例は53歳の男性.心窩部痛を主訴に受診した.胆石発作が疑われ経過観察していたが,腹痛の改善を認めなかったため,腹部超音波検査・CT検査を施行したところ,肝外側区域に約3.5cm大の膿瘍と内部に針状陰影を認めた.異物の胃壁から肝への穿通による肝膿瘍と診断した.抗生剤による保存的治療を行い炎症の改善を得た後,異物除去を目的に腹腔鏡下肝外側区域切除術を施行した.異物は爪楊枝であった.術後は特に合併症なく,術後10日目に退院となった.異物の胃壁穿通による肝膿瘍の診断にはCT検査が有効であった.腹腔鏡下手術は低侵襲で可能であり,異物除去に有効であった.
- 著者
- 富丸 慶人 後藤 邦仁 小林 省吾 永野 浩昭 森 正樹 土岐 祐一郎 江口 英利 伊藤 壽記 野口 洋文 宮下 和幸 川本 弘一 岩上 佳史 秋田 裕史 野田 剛広
- 出版者
- 一般社団法人 日本移植学会
- 雑誌
- 移植 (ISSN:05787947)
- 巻号頁・発行日
- vol.54, no.4, pp.217-222, 2019
<p>Total pancreatectomy with islet autotransplantation is an ideal surgical procedure used to relieve chronic pain derived from the pancreatitis, while insulin-dependent diabetes is inevitably induced after the surgery. Islet autotransplantation combined with a total pancreatectomy can reduce the risk of severe diabetes by preserving available islet cells. We experienced a case with hereditary pancreatitis, which is a rare inherited condition characterized by recurrent acute pancreatitis and/or chronic pancreatitis. The case was that of a female in her thirties who was introduced to our hospital due to treatment-refractory abdominal pain derived from repeated pancreatitis even after surgical treatments. At the introduction, the pain was uncontrollable even by opioid use, and oral intake was impossible due to increase of the pain after the intake. She was genetically diagnosed with hereditary pancreatitis. For relieving the pancreatitis-derived pain, total remnant pancreatectomy with islet autotransplantation was planned. After the pancreatectomy, islet cells were extracted from the excised remnant pancreas, and injected into the portal vein for liver autotransplantation. The pain was completely relieved for her after the surgery, suggesting improvement of her quality-of-life. A glucose tolerance test and glucagon loading test performed one month after the surgery showed C-peptide secretion as the blood glucose rose. However, the serum c-peptide level and SUIT index had been gradually decreased after the surgery, and she is now treated with insulin. The case suggested that total pancreatectomy with islet autotransplantation is useful for improvement of the patient's quality of life by controlling the pain in cases with hereditary pancreatitis.</p>
