腹腔鏡下手術中の虫垂動脈損傷によって遅発性虫垂壊死周囲膿瘍を生じた1例

抄録

　Laparoscopic surgery requires reliance on visual information, and there are several points to be aware of when performing such surgery. Intestinal injury is a serious complication of endoscopic surgery, delayed detection of which can have a fatal course due to generalized peritonitis. We report a case of pelvic abscess caused by perforation of the appendix after surgery.

　A 50-year-old woman underwent laparoscopic total hysterectomy, bilateral adnexal resection, and pelvic lymph node dissection for stage IA equivalent endometrial cancer (grade 1) (surgical duration: 292 minutes, bleeding volume: small amount). Five days postoperatively, she had right lower abdominal pain and fever, and an increased inflammatory response. Contrast-enhanced CT examination revealed a poor contrast-enhanced abscess in the right pelvis and appendix, leading to the suspicion of perforation. When we tried a trial laparotomy, her appendix was necrotic and had collapsed into the cavity created by the surgical dissection, forming an abscess. We performed appendectomy and lavage drainage.

　We were able to confirm a case report of direct damage to the appendix during laparoscopic surgery, but not a report of perforation of the appendix due to appendicular artery injury. Looking back at the surgical video, it was possible that the appendicular artery was amputated by monopolar (cut mode) electrocautery during fat amputation while expanding the broad membrane. It is important to remember that the appendicular artery might not bleed when electrocauterized, and to understand the three-dimensional anatomy of the ileocecal region when dissecting retroperitoneum.