腹腔鏡下付属器摘出術中における非穿孔性の漿膜筋層直腸損傷に続発する骨盤膿瘍

抄録

  Rectal injury is a serious complication of laparoscopic surgery and is associated with poor prognosis. We describe a patient who developed a pelvic abscess secondary to bacterial infection after a seromuscular rectal injury during laparoscopic surgery, who was successfully treated with drainage alone. Laparoscopic bilateral adnexectomy was performed for bilateral chocolate cysts; however, she developed fever and abdominal pain, 5 days postoperatively. Computed tomography revealed an intrapelvic abscess, and the intraoperative video recording led to a suspicion of rectal injury. Based on bacterial cultures of pus from the abscess, she was diagnosed with infection transmitted from the site of rectal injury. However, colonoscopy did not reveal any rectal mucosal injury. Therefore, we concluded that the injury was confined to the seromuscular layer. The abscess was successfully treated with drainage and antibiotics. Pelvic abscesses may occur secondary to seromuscular injuries without complete perforation of the rectal mucosa. Notably, drainage and antibacterial drugs are effective and emergency surgery is not required in patients without perforation. Colonoscopy may be useful to determine the treatment course.