Presacral Abscess 환자에서 복강경술식을 이용한

배액술

부천성가병원

외과 R2 이정민 Pf. 박일영

Presacral abscessPresacral abscess

Cause of the disease

Complication of - 복회음절개술

- 감염성 질환 ; 충수돌기염 ,

게실염 , 결핵성 골수염…

- 외상성 질환

- Crohn’s disease

- Tuboovarian abscess

Presacral abscessPresacral abscess

Anatomy of the presacral space

- Bladder

- Bowel

- skeletal or

neurovascular

structure

- Genital organ

Presacral abscessPresacral abscess

Draiage procedure

- Percutaneous drainage by

using fluoroscopic, CT, or

transabdominal sonogrphic

guidance

- Surgical drainage

Case 1. CHIEF COMPLAINTCase 1. CHIEF COMPLAINT

Back pain

Name : Name : 맹 맹 O O 호호 Age/Sex : 39/MAge/Sex : 39/M

PRESENT ILLNESSPRESENT ILLNESS

39 세 남자 환자 , 과거력에서 6 년 전 결핵 진단받고 항결핵제를 4 년간 복용 후 완치 판정을 받은 적이 있으며 , 6 개월간 지속된 요통을 주소로 정형외과 내원하여 시행한 척추 자기공명영상 결과 5 번째 요골과 천골에 결핵척추염이 의심되어 내원함 .

HistoryPAST HISTORYPAST HISTORY

• Hypertension(-), Tbc(+), DM(-),Hepatitis(-) • Op Hx (+): 5 년 전 TB peritonitis 로 OP

FAMILY HISTORYFAMILY HISTORY N-S

SOCIAL HISTORYSOCIAL HISTORY• Smoking Hx (-)• Alcohol Hx (+)

Review Of System

GeneralGeneral fever (-), chilling (-) fever (-), chilling (-) vertigo/dizziness (vertigo/dizziness ( // ), headache (-)), headache (-) weight loss (-)weight loss (-) Fatigue(-)Fatigue(-)

poor oral intake (+)poor oral intake (+) jaundice(-)jaundice(-)RespiratoryRespiratory cough(-), sputum(-), rhinorrhea(cough(-), sputum(-), rhinorrhea( ))Cardiovascular Cardiovascular chest pain (chest pain ( ), cyanosis (), cyanosis ( ))Gastrointestinal Gastrointestinal nausea/vomiting (-/-)nausea/vomiting (-/-)

diarrhea (-), constipation (-)diarrhea (-), constipation (-)Genitourinary Genitourinary dysuria (dysuria ( ), frequency (), frequency ( ))

Physical Examination

Vital signVital sign 110/70110/70 ㎜㎜ Hg ― 82/min ― 18/min ― Hg ― 82/min ― 18/min ― 36.9℃36.9℃

Mental status Mental status alertalertGeneral appearance General appearance Not so ill appearanceNot so ill appearance Head & neck normocephaly, no neck vein Head & neck normocephaly, no neck vein

distensiondistension no cervical lymphadenopathyno cervical lymphadenopathy

Eyes isocoria with pupillary light reflex (+Eyes isocoria with pupillary light reflex (++/++)+/++)

notanemic conjunctivae, anicteric notanemic conjunctivae, anicteric sclerasclera

ENTENT no pharyngeal injectionno pharyngeal injection no tonsillar enlargementno tonsillar enlargementChestChest CBS without raleCBS without rale RHB without murmurRHB without murmurAbdomenAbdomen soft and flatsoft and flat

Low abd. : Low abd. : tenderness(-)/R. tenderness(-) tenderness(-)/R. tenderness(-)

Back & extremities Back & extremities grossly freegrossly free

Laborotory Findings Complete blood countComplete blood count Hb / Hct : 14.0 g/dL /43.7%Hb / Hct : 14.0 g/dL /43.7% WBC count : 9.7×10WBC count : 9.7×1099/L(Seg. 49%)/L(Seg. 49%)

Blood chemistryBlood chemistry FBS : 111 FBS : 111 ㎎㎎ /dL BUN / Cr : 5.5/ 0.8 /dL BUN / Cr : 5.5/ 0.8 ㎎㎎ /dL/dL AST / ALT : 19 / 16 IU/LAST / ALT : 19 / 16 IU/L T. b / D.b: 0.56 / 0.14 mg/dLT. b / D.b: 0.56 / 0.14 mg/dL NaNa++ / K / K++ : 141 / 5.0 mEq/L : 141 / 5.0 mEq/L

Coagulation profileCoagulation profile PT : 11.7secPT : 11.7sec

aPTT : 32.2 secaPTT : 32.2 sec

Operation

• Trocar: umblical 10mm Trocar: umblical 10mm right flank 5mmright flank 5mm suprapubic 5mmsuprapubic 5mm

• RectumRectum 의 의 right posterior right posterior 에 에 bulging mass bulging mass 관찰관찰됨됨 . . • Rectum Rectum 의 의 right mesentery right mesentery 를 를 dissection dissection 하자하자 abscess cavity abscess cavity 관찰되어 관찰되어 aspiration aspiration 하였고 하였고 pus pus 나와 나와 drainage drainage 시키고 시키고 biopsy biopsy 시행 후 시행 후 Op Op 마침마침 . .

Case 2. CHIEF COMPLAINTCase 2. CHIEF COMPLAINT

Lower abdominal pain

Onset: 1 주일 전

Name : Name : 박 박 O O 숙숙 Age/Sex : 55/FAge/Sex : 55/F

PRESENT ILLNESSPRESENT ILLNESS

55 세 여자환자 , 과거력에서 8 년 전

자궁경부암 진단 후 항암치료와 방사선 치료 받은 적 있으

며 , 내원 1 주일 전 하복부 통증 발생하여 점차

악화 되는 양상의 하복부 통증을 주소로 응급실 내원 하였다 .

HistoryPAST HISTORYPAST HISTORY

• Hypertension(+), Tbc(-), DM(-),Hepatitis(-) • Op Hx (+): spinal stenosis 로 op 시행

FAMILY HISTORYFAMILY HISTORY N-S

SOCIAL HISTORYSOCIAL HISTORY• Smoking Hx (-)• Alcohol Hx (-)

Review Of System

GeneralGeneral fever (-), chilling (-) fever (-), chilling (-) vertigo/dizziness (vertigo/dizziness ( // ), headache (-)), headache (-) weight loss (-)weight loss (-) Fatigue(-)Fatigue(-)

poor oral intake (-) poor oral intake (-) jaundice(-)jaundice(-)RespiratoryRespiratory cough(-), sputum(-), rhinorrhea(cough(-), sputum(-), rhinorrhea( ))Cardiovascular Cardiovascular chest pain (chest pain ( ), cyanosis (), cyanosis ( ))Gastrointestinal Gastrointestinal nausea/vomiting (-/-)nausea/vomiting (-/-)

diarrhea (-), diarrhea (-), constipation (+)constipation (+)Genitourinary Genitourinary dysuria (dysuria ( ), frequency (), frequency ( ))

Physical Examination

Vital signVital sign 120/70120/70 ㎜㎜ Hg ― 108/min ― 20/min ― Hg ― 108/min ― 20/min ― 37.8℃37.8℃

Mental status Mental status alertalertGeneral appearance General appearance Not so ill appearanceNot so ill appearance Head & neck normocephaly, no neck vein Head & neck normocephaly, no neck vein

distensiondistension no cervical lymphadenopathyno cervical lymphadenopathy

Eyes isocoria with pupillary light reflex (+Eyes isocoria with pupillary light reflex (++/++)+/++)

notanemic conjunctivae, anicteric notanemic conjunctivae, anicteric sclerasclera

ENTENT no pharyngeal injectionno pharyngeal injection no tonsillar enlargementno tonsillar enlargementChestChest CBS without raleCBS without rale RHB without murmurRHB without murmurAbdomenAbdomen soft and flatsoft and flat

Low abd. : Low abd. : tenderness(+)/R. tenderness(-) tenderness(+)/R. tenderness(-)

Back & extremities Back & extremities grossly freegrossly free

Laborotory Findings Complete blood countComplete blood count Hb / Hct : 11.2 g/dL /32.6%Hb / Hct : 11.2 g/dL /32.6% WBC count : 9,100×10WBC count : 9,100×1099/L(Seg. 49%)/L(Seg. 49%)

Blood chemistryBlood chemistry FBS : 101 FBS : 101 ㎎㎎ /dL BUN / Cr : 7.6/ 0.5 /dL BUN / Cr : 7.6/ 0.5 ㎎㎎ /dL/dL AST / ALT : 17 / 42 IU/LAST / ALT : 17 / 42 IU/L NaNa++ / K / K++ : 137 / 3.3 mEq/L : 137 / 3.3 mEq/L

Coagulation profileCoagulation profile PT : 12.1secPT : 12.1sec

aPTT : 44.2 secaPTT : 44.2 sec

Operation

• Trocar: umblical 10mm Trocar: umblical 10mm right flank 5mmright flank 5mm suprapubic 5mmsuprapubic 5mm

• RectumRectum 의 의 right posterior right posterior 에 에 bulging mass bulging mass 관찰관찰됨됨 . . • Rectum Rectum 의 의 right mesentery right mesentery 를 를 dissection dissection 하자하자 abscess cavity abscess cavity 관찰되어 관찰되어 aspiration aspiration 하였고 하였고 pus pus 나와 나와 drainage drainage 시키고 시키고 biopsy biopsy 시행 후 시행 후 Op Op 마침마침 . .