十二指腸穿孔による非定型逆腹膜膿瘍の画像所見と臨床的特徴：1 症例報告と文献のレビュー

Imaging findings and clinical features of atypical retroperitoneal abscess caused by duodenal perforation: a case report and review of the literature.

• Xijin Mao
• Ning Yu
• Xingfang Jia
• Wanfeng Fan

抄録

はじめに:

十二指腸穿孔による逆腹膜膿瘍は臨床的には比較的まれな疾患である。後腹膜膵臓の頭部に局所的に高密度の陰影を認めた1例を報告する。

INTRODUCTION: A retroperitoneal abscess caused by duodenal perforation is a relatively rare disease clinically. We report the case of a patient with a local high-density shadow at the head of the retroperitoneal pancreas.

症例紹介:

28歳の中国人男性が過食・多飲後に発熱と腹痛を呈した。身体所見では上腹部に軽度の圧痛を認めた。臨床検査では白血球数24.06 10/L，好中球絶対値18.81 10/L，CT検査では後腹膜腔内の嚢胞壁が不均一に強調された不規則な軟部組織腫瘤を認めた．胃カメラ検査では十二指腸球前壁に瘻孔を認めた。十二指腸瘻の内視鏡的吻合クリップシステム（オーバーザスコープクリップ）が成功した。術後は栄養チューブを用いた経鼻栄養を行い、経験的に抗感染薬、抗酸剤、胃保護剤の投与を行った。患者の体温は徐々に正常に戻り、腹痛も軽減した。

CASE PRESENTATION: A 28-year-old Chinese man presented with fever and abdominal pain after overeating and heavy drinking. On physical examination, he had mild tenderness in his upper abdomen. Laboratory examination results showed a white blood cell count of 24.06 10/L and a neutrophil absolute value of 18.81 10/L, and a computed tomography scan showed an irregular soft tissue mass with uneven enhancement of the cystic wall in the retroperitoneal space. Gastroscopy showed that there was a fistula in the anterior wall of the duodenal bulb. Endoscopic anastomosis clip system (over-the-scope clip) of the duodenal fistula was performed successfully. After the operation, nasal feeding was provided with a nutrition tube, and empiric anti-infection, acid-inhibiting, and stomach-protecting treatments were administered. Our patient's body temperature gradually returned to normal, and his abdominal pain decreased.

結論:

十二指腸穿孔による後腹膜膿瘍は、臨床症状と腹部CT撮影により診断できる。治療法の選択は、正確でタイムリーな臨床データおよび画像データに基づいて行うべきである。

CONCLUSIONS: A retroperitoneal abscess caused by duodenal perforation can be diagnosed by clinical symptoms and abdominal computed tomography imaging. The choice of treatment should be based on accurate and timely clinical and imaging data.