Departmental Bulletin Paper 3次元Multi-detectorCT画像により早期診断し,大腸内視鏡下に摘出し得た爪楊枝による超高齢者大腸穿通の1例
Endoscopic removal of a toothpick penetrating the sigmoid colon diagnosed by multi-detector CT with 3D reconstruction

杉山, 浩平  ,  松山, 友美  ,  白井, 謙一  ,  簗瀬, 公嗣  ,  浪崎, 正  ,  山崎, 正晴  ,  吉治, 仁志  ,  福井, 博

66 ( 1-2 )  , pp.25 - 30 , 2015-04-30 , 奈良医学会 , 奈良県立医科大学
We present herein a case of sigmoid penetration, caused by accidental ingestion of a toothpick and resolved by endoscopic removal. An 85-year-old woman with moderate dementia was referred to our hospital by the primary care doctor for a further examination of minor localized left lower quadrant rebound tenderness. Multi-detector CT (MDCT) revealed sigmoid colon penetration by a linear structure and adjacent opaque adipose tissue. She was admitted as an emergency case to our hospital with localized peritonitis. A 3D reconstruction image confirmed that a 6 cm-long toothpick had pierced the sigmoid colon. However, the abdominal CT scan showed sigmoid colon penetration with no evidence of abscess formation or free air. Toothpick ingestion-related penetration was successfully managed with an endoscopic retrieval procedure followed by broad-spectrum antibiotic coverage. She was eventually discharged in fair condition. Here, we report this case of an 85-year-old female patient with accidentaltoothpick ingestion who was diagnosed with sigmoid colon penetration by MDCT with 3Dreconstruction, and underwent successful endoscopic removal.

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