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卵巣真皮嚢胞摘出術の異所性流出による肉芽腫性腹膜炎：症例報告と文献レビュー
Granulomatous peritonitis caused by iatrogenic spillage of ovarian dermoid cystectomy: a case report and literature review.
PMID: 32550736 DOI: 10.5468/ogs.19189.
抄録
39歳の女性が3ヵ月前に地元の病院で腹腔鏡下卵巣真皮層膀胱摘出術を受けた後、軽度の発熱と腹痛が続いていた。腹部CT検査の結果，大黄門と小黄門に多数の小結節を伴うびまん性の不均一な脂肪浸潤が認められ，腹水と腹膜頭頂部の肥厚を伴った腹水が認められた．この患者は探索的腹腔鏡検査を受け、骨盤部分腹膜切除術、肉芽腫の切除、大規模な灌水による癒着治癒を行った。この患者は腹腔鏡下手術で治療に成功し、すべての生殖器官は手術合併症なく免れた。腹膜炎を避けるために、卵巣真皮嚢胞摘出術の際には、嚢胞内容物の完全除去と大規模な灌水を行うべきである。保存的な外科的治療は、異所性破裂によって誘発された肉芽腫性腹膜炎の治療には良い選択かもしれません。
A 39-year-old nulliparous woman experienced continuous mild fever and abdominal pain since undergoing laparoscopic ovarian dermoid cystectomy 3 months previously in a local hospital. Abdominal computed tomography revealed diffuse heterogeneous fat infiltrations with numerous micronodules in the greater and lesser omentum, combined with ascites with thickening of the parietal peritoneum. The patient underwent exploratory laparoscopy, which included partial pelvic peritonectomy, excision of granulomas, and adhesiolysis with massive irrigation. The patient was treated successfully with laparoscopic surgery and all reproductive structures were spared without operative complications. To avoid peritonitis, complete removal of cyst contents and massive irrigation should be performed during ovarian dermoid cystectomy. Conservative surgical treatment may be a good choice for treating granulomatous peritonitis induced by iatrogenic rupture.