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Permalink : https://petit.lib.yamaguchi-u.ac.jp/18725
山口医学 Volume 60 Issue 1-2
published_at 2011-04-30
A case of impalement injury to the rectum
杙創による直腸穿孔の1例
Miyahara Makoto
Nishiyama Mitsuo
Yoshida Kumiko
Ichimiya Masamichi
Tada Kosuke
Fujita Yuji
Akiyama Norio
Kubo Hidefumi
Hasegawa Hiroyasu
Miyashita Hiroshi
About This Article
Descriptions
症例は37歳,男性.トラックの荷台から飛び降りた際,立てかけてあった熊手の柄が肛門より刺入した.柄を自己抜去した後,肛門出血および疼痛が出現し当院救急搬送された.受診時,下腹部に軽度圧痛があり,肛門の5時から8時の方向にかけ挫傷を認めた.腹部CTで右傍直腸腔内に血腫および遊離ガスを認め,注腸造影で造影剤の腸管外への漏出を認めた.以上より,杙創による直腸穿孔と診断し緊急手術を施行した.開腹時,右傍直腸腔内に血腫,体毛,衣服の断片が存在し,直腸Rb部右壁に1.8cm大の穿孔を認めた.穿孔部を縫合閉鎖し,Ｓ状結腸を用いた人工肛門を作成した.また経肛門的に裂創部粘膜を縫合した.経過は良好で術後25日目に退院,8ヵ月後に人工肛門を閉鎖し完治した.杙創において,会陰部や肛門周囲から刺入した場合には骨盤内臓器や腹腔内臓器を損傷する危険性があり,受傷早期に臓器損傷の有無とその程度を把握し,これに応じた治療を迅速に行う必要がある.また体腔内に異物が存在することもあり注意すべきであると思われた.
Creator Keywords
杙創
刺杭創
直腸穿孔
直腸杙創
Other Article
PP. 11 - 16