術前診断しえた魚骨のＳ状結腸穿通による腹部放線菌症の１例

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  • Abdominal Actinomycosis Caused by a Fish Bone Penetrating through the Sigmoid Colon which was Successfully Diagnosed Preoperatively.

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Abdominal actinomycosis is rare, and its diagnosis is difficult to make preoperatively. We report a case of abdominal actinomycosis which was successfully diagnosed preopratively. A 44-year-old man was admitted to our hospital because of an abdominal mass and mild fever. Physical examination revealed a hard, nontender, fixed mass in the left lower abdominal quadrant. Laboratory data showed leucocytosis, thrombocythemia and an elevated CRP level. CT scan demonstrated an infiltrating mass in the anterior left abdomen, extending to the rectal muscle. 97Ga scintigraphy showed strong uptake of RI in the mass. Thus it was suspected to be an inflammatory mass, and the patient was treated with antibiotics (SBT/ ABPC) intravenously. He improved with this treatment. CT scan on the 15th hospital day revealed a clear straight line with high density in the shrunk mass. Excisional biospy was performed on the 22nd day, and a diagnosis of abdominal actinomycosis was established by hisotopathtological examination. Resection of the mass carried out on the 35th day. At surgery, the sigmoid colon was adherent to the mass and also a fish bone was found embedded in the mass. We thought that this case was caused by a fish bone penetrating thorough the sigmoid colon. The postoperative course was uneventful, and he discharged on the 14th postoperative day.

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