腹腔鏡下卵管切除術後の腹腔内膿瘍に対してCTガイド下穿刺ドレナージを施行した1例

Abstract

Case: The patient, 35-year-old primipara, was brought to our hospital by ambulance with lower abdominal pain. Under a diagnosis of ectopic pregnancy-related rupture of the left fallopian tube, laparoscopic left salpingectomy was performed on the same day. During surgery, 1,000 mL of blood was aspirated but large clots remained. The course was favorable, and the patient was discharged 7 days after surgery. However, she was brought to our hospital by ambulance with lower abdominal pain 19 days after surgery. Under a diagnosis of infection related to hematoma remaining in the abdominal cavity, an antimicrobial agent was administered, but 39°C or higher persisted. Pelvic CT revealed an abscess with enhancement of the capsule in the left lower abdomen. CT-guided drainage of the bloody abscess was performed 20 days after surgery. Pyretolysis was achieved the following day, and the patient was discharged. Discussion: Percutaneous abscess drainage is routinely performed under ultrasonic guidance. On the other hand, CT-guided approach could facilitate selection of sites in which drainage ismore safely and effectively conducted. The use of an aspirating tube or closing drain with a large diameter during laparoscopic surgery may reduce the risk of infection. For laparoscopic surgery for ectopic pregnancy-related rupture, techniques regarding the management of massive clots in the abdominal cavity must be devised. Furthermore, CT-guided drainage of abscess formation may be an effective treatment method.