超音波誘導下経直腸ドレナージにて治癒せしめた小児ダグラス窩膿瘍の1例

抄録

This is a report of a case of Pelvic abscess which was treated successfully by per rectal catheter drainage using ultrasound guidance. A 7-year-old female, who had undergone an appendectomy several days ago at another hospital, was admitted with persistent high fever, abdominal pain, nausea and vomiting. A large tender abdominal mass was found in her lower abdomen. Ultrasound examination was performed using a 5 MHz linear transducer. An abnormal hypoechoic mass with an internal echo and a hyperechoic irregularly thick wall was shown by sonogram in Douglas's pouch. Under general anesthesis, a 14 Fr. trochar catheter was inserted into the abscess cavity through the rectum under real time ultrasound observation, and the purulent exudate was fully aspirated. After aspiration and generous lavage, the catheter was placed on continuous suction. On the next day, the patient became cheerful and was without fever or abdominal pain, and she left our hospital on the 15th day. Percutaneous drainage with ultrasoud guidance for patients with a suspected free abdominal abscess is not so popular because of the unclear picture, possible peritoneal contamination or puncture of the bowel. However, an abscess in Douglas's pouch becomes clearly seen in the echo window behind the urinary bladder, and the abscess can be drained safely without a significant incidence of complications.