腹腔鏡下子宮悪性腫瘍手術後に生じた骨盤内膿瘍に対して腹腔鏡下ドレナージが奏効した1例

抄録

  Pelvic abscess formation is a known postoperative complication in women undergoing surgery including lymph node dissection for gynecological malignancies. We describe a woman in whom computed tomography (CT)-guided drainage was difficult owing to widespread pelvic abscess formation after laparoscopic surgery for uterine endometrial cancer. A 56-year-old woman presented with a 2-month history of irregular genital bleeding. She was diagnosed with early stage endometrial cancer and underwent laparoscopic hysterectomy with bilateral oophorectomy and pelvic lymph node dissection. She developed lower abdominal pain and fever (≥38°C) on postoperative day 13. Contrast-enhanced abdominal CT revealed abscess formation between the vaginal stump and the right external iliac artery lesion. She underwent transvaginal drainage and was administered antibiotics; however, she showed persistent inflammation, and CT revealed a new abscess in the upper abdominal cavity. Laparoscopic drainage was performed 22 days after the first surgery, and port placement was performed in conjunction with the previous operation wound. The patient developed widespread abscesses in the external and internal side of the right iliac artery, as well as the vaginal stump and opened to wash with 3000 mL of saline. Postoperative subsidence of inflammation was observed. Surgical drainage is indicated for postoperative pelvic abscesses. Laparoscopic drainage is a useful minimally invasive method in such cases.