外傷性膵十二指腸破裂の１例

概要

論文の詳細を見る
Traumatic duodenal rupture results in severe peritonitis because of pancreatic juice and bile.However, its diagnosis is difficult when it occurs in the retroperitoneum. Its surgical treatment consists of closing the rupture with sutures, and covering and decompressing the suture site. Unfortunately, surgical treatment is easily complicated by leakage. We experienced a case of traumatic duodenal rupture with pancreatic injury. A 63-year-old woman suffered abdominal trauma in a traffic accident and was admitted to our hospital on April 4, 1999. She complained of tenderness in the right lower abdomen but muscular guarding and rebound tenderness were mild. Abdominal radiograph and CT scan did not suggest gastrointestinal rupture, and we discovered her duodenal rupture in the 3rd portion with pancreatic injury by emergency laparotomy on April 5. At the operation,we closed the rupture with direct suture,covered the suture site with peripheral connective tissue, and decompressed by leaving a gastric tube in the jejunum. After the operation the patient experienced leakage, wound dehiscence and pancreatic fistula, so we performed a pancreatoduodenectomy on April 15. After the second operation she suffered an MRSA intra abdominal abscess and pancreatic fistula. Somatostatin reduced the leakage of pancreatic juice,and she was discharged on August 8,1999.
信州医学会の論文
2000-04-10