Press-through-package誤飲による回腸穿孔性腹膜炎の1例

DOI Web Site 被引用文献15件 参考文献33件
  • 松村 博臣
    Department of Surgery, Kyoto Second Red Cross Hospital
  • 泉 浩
    Department of Surgery, Kyoto Second Red Cross Hospital
  • 土橋 洋史
    Department of Surgery, Kyoto Second Red Cross Hospital
  • 柿原 直樹
    Department of Surgery, Kyoto Second Red Cross Hospital
  • 飯塚 亮二
    Department of Surgery, Kyoto Second Red Cross Hospital
  • 宮田 圭悟
    Department of Surgery, Kyoto Second Red Cross Hospital
  • 井川 理
    Department of Surgery, Kyoto Second Red Cross Hospital
  • 藤井 宏二
    Department of Surgery, Kyoto Second Red Cross Hospital
  • 高橋 滋
    Department of Surgery, Kyoto Second Red Cross Hospital
  • 竹中 温
    Department of Surgery, Kyoto Second Red Cross Hospital

書誌事項

タイトル別名
  • Peritonitis Due to Perforation of the Small Intestine by a Press-Through-Package

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A 77-year-old man with acute onset of lower abdominal pain and generalized peritonitis showed numerous diverticula along the descending and sigmoid colon and ascites in abdominal computed tomography (CT). We diagnosed peritonitis secondary to perforation of the colonic diverticulum and conducted emergency laparotomy. The colon was intact but the small intestine had been perforated by a press-through-package (PTP) still containing a tablet. We removed the PTP and conducted wedge resection to close the perforation. Small intestinal perforation by a PTP is rarely diagnosed because most patients do not realize they have swallowed their medication with the packaging and have no specific complaints or radiologic signs. We conducted an experiment to determine the usefulness of abdominal CT in diagnosing PTP ingestion. We created a sausage-shaped cylinder as a phantom of the intestine, and was inserted an intact PTP, including a tablet in it. The phantom was immersed in a vinyl bag filled with water and CT was conducted. The PTP appeared as a triple-contrasted target lesion, consisting of high, low and slightly lower densities, corresponding to the tablet, air in the dome, and water around the PTP. This unusual sign in the intestine strongly suggests the presence of an ingested PTP and is an indication for surgery when peritonitis is present. Small intestinal perforation following PTP ingestion is relatively rare, and mostly due to carelessness. Improved design to avoid accidental ingestion, particularly in the elderly or impaired, and better training in PTP use should decrease the incidence of this problem.

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