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Presacral Abscess 환자에서 복강경술식을 이용한 배액술

Presacral Abscess 환자에서 복강경술식을 이용한 배액술. 부천성가병원 외과 R2 이정민 Pf. 박일영. Presacral abscess. Cause of the disease Complication of - 복회음절개술 - 감염성 질환 ; 충수돌기염 , 게실염 , 결핵성 골수염 … - 외상성 질환 - Crohn ’ s disease - Tuboovarian abscess.

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Presacral Abscess 환자에서 복강경술식을 이용한 배액술

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  1. Presacral Abscess 환자에서 복강경술식을 이용한 배액술 부천성가병원 외과 R2 이정민 Pf. 박일영

  2. Presacral abscess • Cause of the disease Complication of- 복회음절개술 - 감염성 질환 ; 충수돌기염, 게실염, 결핵성 골수염… - 외상성 질환 - Crohn’s disease - Tuboovarian abscess

  3. Presacral abscess • Anatomy of the presacral space - Bladder - Bowel - skeletal or neurovascular structure - Genital organ

  4. Presacral abscess • Draiage procedure - Percutaneous drainage by using fluoroscopic, CT, or transabdominal sonogrphic guidance - Surgical drainage

  5. Case 1. CHIEF COMPLAINT Back pain Name : 맹 O 호 Age/Sex : 39/M

  6. PRESENT ILLNESS 39세 남자 환자, 과거력에서 6년 전 결핵 진 단받고 항결핵제를 4년간 복용 후 완치 판정을 받 은 적이 있으며, 6개월간 지속된 요통을 주소로 정형외과 내원하여 시행한 척추 자기공명영상 결 과 5번째 요골과 천골에 결핵척추염이 의심되어 내원함.

  7. History PAST HISTORY • Hypertension(-), Tbc(+), DM(-),Hepatitis(-) • Op Hx (+): 5년 전 TB peritonitis 로 OP FAMILY HISTORY N-S SOCIAL HISTORY • Smoking Hx (-) • Alcohol Hx (+)

  8. Review Of System General fever (-), chilling (-) vertigo/dizziness (­/­), headache (-) weight loss (-)Fatigue(-)poor oral intake (+) jaundice(-) Respiratory cough(-), sputum(-), rhinorrhea(­) Cardiovascular chest pain (­), cyanosis (­) Gastrointestinal nausea/vomiting (-/-) diarrhea (-), constipation (-) Genitourinary dysuria (­), frequency (­)

  9. Physical Examination Vital sign 110/70㎜Hg ― 82/min ― 18/min ― 36.9℃ Mental status alert General appearance Not so ill appearance Head & neck normocephaly, no neck vein distension no cervical lymphadenopathy Eyes isocoria with pupillary light reflex (++/++) notanemic conjunctivae, anicteric sclera ENT no pharyngeal injection no tonsillar enlargement Chest CBS without rale RHB without murmur Abdomen soft and flat Low abd. : tenderness(-)/R. tenderness(-) Back & extremities grossly free

  10. Laborotory Findings Complete blood count Hb / Hct : 14.0 g/dL /43.7% WBC count : 9.7×109/L(Seg. 49%) Blood chemistry FBS : 111 ㎎/dL BUN / Cr : 5.5/ 0.8 ㎎/dL AST / ALT : 19 / 16 IU/L T. b / D.b: 0.56 / 0.14 mg/dL Na+ / K+ : 141 / 5.0 mEq/L Coagulation profile PT : 11.7sec aPTT : 32.2 sec

  11. Operation • Trocar: umblical 10mm right flank 5mm suprapubic 5mm • Rectum의 right posterior 에 bulging mass 관찰 됨. • Rectum 의 right mesentery 를 dissection 하자 abscess cavity 관찰되어 aspiration 하였고 pus 나와 drainage 시키고 biopsy 시행 후 Op 마침.

  12. Case 2. CHIEF COMPLAINT Lower abdominal pain Onset: 1주일 전 Name : 박 O 숙 Age/Sex : 55/F

  13. PRESENT ILLNESS 55세 여자환자, 과거력에서 8년 전 자궁경부암 진단 후 항암치료와 방사선 치료 받은 적 있으며, 내원1주일 전 하복부 통증 발생하여 점차 악화 되는 양상의 하복부 통증을 주소로 응급실 내원 하였다.

  14. History PAST HISTORY • Hypertension(+), Tbc(-), DM(-),Hepatitis(-) • Op Hx (+): spinal stenosis 로 op 시행 FAMILY HISTORY N-S SOCIAL HISTORY • Smoking Hx (-) • Alcohol Hx (-)

  15. Review Of System General fever (-), chilling (-) vertigo/dizziness (­/­), headache (-) weight loss (-)Fatigue(-) poor oral intake (-) jaundice(-) Respiratory cough(-), sputum(-), rhinorrhea(­) Cardiovascular chest pain (­), cyanosis (­) Gastrointestinal nausea/vomiting (-/-) diarrhea (-), constipation (+) Genitourinary dysuria (­), frequency (­)

  16. Physical Examination Vital sign 120/70㎜Hg ― 108/min ― 20/min ― 37.8℃ Mental status alert General appearance Not so ill appearance Head & neck normocephaly, no neck vein distension no cervical lymphadenopathy Eyes isocoria with pupillary light reflex (++/++) notanemic conjunctivae, anicteric sclera ENT no pharyngeal injection no tonsillar enlargement Chest CBS without rale RHB without murmur Abdomen soft and flat Low abd. : tenderness(+)/R. tenderness(-) Back & extremities grossly free

  17. Laborotory Findings Complete blood count Hb / Hct : 11.2 g/dL /32.6% WBC count : 9,100×109/L(Seg. 49%) Blood chemistry FBS : 101 ㎎/dL BUN / Cr : 7.6/ 0.5 ㎎/dL AST / ALT : 17 / 42 IU/L Na+ / K+ : 137 / 3.3 mEq/L Coagulation profile PT : 12.1sec aPTT : 44.2 sec

  18. Operation • Trocar: umblical 10mm right flank 5mm suprapubic 5mm • Rectum의 right posterior 에 bulging mass 관찰 됨. • Rectum 의 right mesentery 를 dissection 하자 abscess cavity 관찰되어 aspiration 하였고 pus 나와 drainage 시키고 biopsy 시행 후 Op 마침.

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