異食症患者の虫垂異物による急性虫垂炎の1例(Acute appendicitis secondary to a foreign body swallowed by a patient with pica: a case report)

要旨 症例は50歳の男性。既往歴に知的障害，自閉症，異食症があり意思疎通が困難である。嘔吐，発熱を主訴に転院前日にイレウスの診断で前医に入院した。保存的治療で改善が見られず，CTで回盲部付近に高吸収域を認め，異物による閉塞性イレウスと診断され当院転院となった。同日，開腹下でイレウス解除術を行った。術中所見で虫垂異物（ファスナー）による膿瘍形成性穿孔性虫垂炎・癒着性イレウスと診断し，虫垂切除・膿瘍ドレナージ術を行った。異食症患者の虫垂異物による急性虫垂炎は極めて少なく術前診断も困難であったため報告する。 ABSTRACT A 50–year–old man with mental disabilities, autism, and pica visited another hospital with vomiting and high fever a day before he presented to our hospital. He had been diagnosed with ileus, and nasogastric intubation had been performed. He did not show improvement and therefore underwent computed tomography, which showed an area of high density in the right lower quadrant of his abdomen. Owing to a high index of suspicion for small bowel obstruction caused by a foreign body, he was referred to our hospital for further management. Upon admission, he was observed to have high fever and abdominal distention. Although he appeared to have abdominal pain, we could not perform a detailed examination because of a difficulty in communication. An exploratory laparotomy was performed, which showed acute appendicitis with abscess formation. Therefore, he underwent an appendectomy and abscess drainage. We report a rare case of acute appendicitis caused by a foreign body.