帝王切開後の腹腔内膿瘍に対して腹腔鏡下手術が有用であった1例

抄録

  A 33-year-old pregnant woman with type 1 diabetes underwent an emergency cesarean section (CS) because of chorioamnionitis at 40/1 weeks of gestation. She complained of lower abdominal pain and persistent fever postoperatively. Computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen revealed abscesses in the Douglas and bladder uterine fossae. Despite treatment with antibiotics, her symptoms, including fever, and laboratory tests did not improve. Hence, transvaginal ultrasound-guided drainage was attempted on postoperative day 15 but failed due to high viscosity of the pus and thus conservative management was pursued. However, on postoperative day 21, laparoscopic drainage was performed since the patient's condition was resistant to the conservative management. The abscess was found to extend from the pelvis to the upper abdomen. Adhesiolysis and

exhaustive pelvic cavity lavage were performed. The anterior uterine wall scar was repaired by endoscopic sutures and drains were placed. The postoperative course was unremarkable with complete recovery. A repeat MRI scan of the abdomen 5 months postoperatively showed complete resolution of the previously seen abscess. Abscess formation after CS is a rare but fatal complication. Nevertheless, a standardized treatment for post CS intra-abdominal abscess is not yet established and the treatment is decided on a case-by-case basis. Management includes laparotomy, ultrasound or CT-guided drainage, and conservative treatment for most patients. Laparoscopic drainage can be an effective treatment, especially if the pus is highly viscous and resistant to other treatments/modalities.