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

Abstract

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 accidental toothpick ingestion who was diagnosed with sigmoid colon penetration by MDCT with 3D reconstruction, and underwent successful endoscopic removal.