A case of intra-abdominal abscess that developed 4 years after pancreatic cancer surgery

　症例は74歳男性．膵体部癌を指摘され当院消化器外科にて201X 年に膵体尾部切除施行．術後半年間テガフール・ギメラシル・オテラシルカリウム内服． ３ヶ月ごとの computed Tomography（CT）と腫瘍マーカーで当院消化器外科にて経過観察していた．術後４年に腹痛で当院消化器外科外来を受診．CT で新たに胃大弯側から横行結腸にかけて内部壊死を疑う造影不良域を伴った腫瘤性病変を認めた．膵癌の大網播種を疑われ，abdominal ultrasonography（AUS）でも同様に腹膜播種が疑われた．消化器内科で化学療法の方針となり病理学エビデンス取得目的で endoscopic ultrasound-guided fine-needle aspiration（EUSFNA）を施行したが EUSFNA では明らかな腫瘍細胞を認めず，壊死様の蛋白様物質とともに多数の細菌を認めた．採血で炎症反応高値であったことから，膵癌の腹膜播種ではなく腹腔内膿瘍を疑い抗生剤で治療を開始．治療後の画像検査では膿瘍の縮小を認めた．今回膵癌術後４年目に発症した腹腔内膿瘍の一例を経験したため若干の文献的考察を加えて報告する．　We report the case of intra-abdominal abscess that developed 4 years after pancreatic cancer surgery, with a review of the literature. A 74-year-old man was diagnosed with cancer of the pancreatic body and underwent pancreatic tail resection in 201X at the department of gastrointestinal surgery of our hospital. Oral Tegafur, Gimeracil, and Oteracil Potassium chemotherapy was administered for 6 months postoperatively. The patient was followed-up at the department of gastrointestinal surgery, and computed Tomography (CT) and tumor marker assessment were performed every 3 months. Four years after surgery, the patient visited the outpatient clinic of the department of gastrointestinal surgery with a complaint of abdominal pain. CT showed a new mass lesion with poor contrast, and internal necrosis of the transverse colon approximating the gastric curvature was suspected. abdominal ultrasonography (AUS) examination suggested omental and peritoneal dissemination of pancreatic cancer. Endoscopic ultrasound-guided fine-needle aspiration (EUSFNA) biopsy, which was performed for obtaining pathological evidence for chemotherapy as per the policy of the department of gastroenterology, revealed a large number of bacteria along with necrotic-like protein-like substances, but no obvious tumor cells were found. Since hematological examination revealed a strong inflammatory reaction, an intraperitoneal abscess was suspected instead of peritoneal dissemination of pancreatic cancer, and treatment with antibiotics was initiated. Post-treatment imaging showed shrinkage of the abscess

膵癌術後４年目に発症した腹腔内膿瘍の一例

症例報告Case Reportjournal articl