十二指腸潰瘍穿孔の保存的治療中に再燃して腹腔ドレナージにより治癒し得た1例

Abstract

A 37-year-old woman was admitted with high grade fever and severe epigastralgia. Physical examination revealed severe tenderness in the epigastric region with negative bowel sound and Blumberg sign. A CT scan of the abdomen confirmed the presence of fluid collection in the right subphrenic region, Douglas pouch and right pleural cavity. Endoscopic findings revealed a perforated active ulcer at the anterior wall of duodenal bulbs. The patient was managed non-operatively, receiving treatment with i.v. antibiotics, i.v. gama globulin, nasogastric suction, and i.v. H2-blocker. The patient's inflammatory reaction of blood examination improved for a short time, but the inflammatory reaction relapsed on day 6, and repeated CT scans showed that the abdominal fluid collection gradually increased. A 18 Fr catheter for percutaneous drainage was inserted into the fluid collection in the right subphrenic space under ultrasound guidance. Ascites from the catheter was yellowish and turbid, but no bacteria or true fungi were detected from the culture. The patient's fever and inflammatory reaction resolved within 5 days and she was discharged on day 26. We present a patient with a duodenal ulcer who was managed conservatively with percutaneous drainage of associated right subphrenic ascites.