腹部症候を伴わない上行結腸憩室炎から敗血症に至ったと考えられた1例
症例は62歳男性。意識障害を主訴に当院搬送された。来院時Glasgow coma scale10 （E3V3M4）の意識障害を認めるとともに，バイタルサインは体温40.8℃，心拍数140回/分，呼吸数30回/分であった。血液検査所見ではCRP 20.65mg/dL，PCT 25.46ng/mLと高値であり敗血症を呈していると考えられた。初診時あきらかな腹部症候を伴わなかった。精査目的で行った腹部CTで上行結腸に多発する憩室と周囲脂肪織濃度の上昇を認め憩室炎が疑われた。来院時に行った血液培養検査からはKlebsiella pneumoniaとBacillus spp.が検出された。入院後抗菌化学...
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| Published in | Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 34; no. 4; pp. 885 - 888 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本腹部救急医学会
2014
Japanese Society for Abdominal Emergency Medicine |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem.34.885 |
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| Abstract | 症例は62歳男性。意識障害を主訴に当院搬送された。来院時Glasgow coma scale10 （E3V3M4）の意識障害を認めるとともに，バイタルサインは体温40.8℃，心拍数140回/分，呼吸数30回/分であった。血液検査所見ではCRP 20.65mg/dL，PCT 25.46ng/mLと高値であり敗血症を呈していると考えられた。初診時あきらかな腹部症候を伴わなかった。精査目的で行った腹部CTで上行結腸に多発する憩室と周囲脂肪織濃度の上昇を認め憩室炎が疑われた。来院時に行った血液培養検査からはKlebsiella pneumoniaとBacillus spp.が検出された。入院後抗菌化学療法を行い状態は改善し，第13病日退院とした。経過中腹部症候は皆無であった。腹部症候を呈さない憩室炎から敗血症に至る可能性があり，感染源不明の敗血症に遭遇した際には憩室炎を鑑別の一つに取り入れるべきである。 |
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| AbstractList | 症例は62歳男性。意識障害を主訴に当院搬送された。来院時Glasgow coma scale10 （E3V3M4）の意識障害を認めるとともに，バイタルサインは体温40.8℃，心拍数140回/分，呼吸数30回/分であった。血液検査所見ではCRP 20.65mg/dL，PCT 25.46ng/mLと高値であり敗血症を呈していると考えられた。初診時あきらかな腹部症候を伴わなかった。精査目的で行った腹部CTで上行結腸に多発する憩室と周囲脂肪織濃度の上昇を認め憩室炎が疑われた。来院時に行った血液培養検査からはKlebsiella pneumoniaとBacillus spp.が検出された。入院後抗菌化学療法を行い状態は改善し，第13病日退院とした。経過中腹部症候は皆無であった。腹部症候を呈さない憩室炎から敗血症に至る可能性があり，感染源不明の敗血症に遭遇した際には憩室炎を鑑別の一つに取り入れるべきである。 A 62-year-old male with disturbance of consciousness was transferred to our emergency room. On arrival, his Glasgow coma scale was 10 points, heart rate was 140 beats/min, respiratory rate was 30 breaths/min, and temperature was 40.8℃. In the laboratory tests the values of CRP (20.6 mg/dL) and PCT (25.46 ng/mL) were elevated. No abdominal signs and symptoms were observed at the first medical examination. His abdominal computed tomography showed multiple diverticula in his ascending colon and the elevation of fatty density around the diverticula, suggesting colonic diverticulitis. Klebsiella pneumonia and Bacillus spp. were revealed in his blood culture performed on his arrival. After treatment including antibiotic therapy and intensive care, his condition recovered, and he was discharged on the 13th hospital day. No abdominal signs and symptoms were observed throughout his clinical course. Diverticulitis with no abdominal signs and symptoms can be a cause of sepsis, and we should take diverticulitis into account as a differential diagnosis when there is a patient with sepsis of unknown origin. 症例は62歳男性。意識障害を主訴に当院搬送された。来院時Glasgow coma scale10 （E3V3M4）の意識障害を認めるとともに，バイタルサインは体温40.8℃，心拍数140回/分，呼吸数30回/分であった。血液検査所見ではCRP 20.65mg/dL，PCT 25.46ng/mLと高値であり敗血症を呈していると考えられた。初診時あきらかな腹部症候を伴わなかった。精査目的で行った腹部CTで上行結腸に多発する憩室と周囲脂肪織濃度の上昇を認め憩室炎が疑われた。来院時に行った血液培養検査からはKlebsiella pneumoniaとBacillus spp.が検出された。入院後抗菌化学療法を行い状態は改善し，第13病日退院とした。経過中腹部症候は皆無であった。腹部症候を呈さない憩室炎から敗血症に至る可能性があり，感染源不明の敗血症に遭遇した際には憩室炎を鑑別の一つに取り入れるべきである。 |
| Author | 青木, 誠 神戸, 将彦 村田, 将人 金子, 稔 萩原, 周一 大山, 良雄 田村, 遵一 大嶋, 清宏 澤田, 悠輔 |
| Author_FL | 田村 遵一 Aoki Makoto Oshima Kiyohiro Kanbe Masahiko Hagiwara Shuichi Kaneko Minoru Murata Masato Sawada Yusuke 大山 良雄 |
| Author_FL_xml | – sequence: 1 fullname: Aoki Makoto – sequence: 2 fullname: Murata Masato – sequence: 3 fullname: Kaneko Minoru – sequence: 4 fullname: Sawada Yusuke – sequence: 5 fullname: Kanbe Masahiko – sequence: 6 fullname: Hagiwara Shuichi – sequence: 7 fullname: 大山 良雄 – sequence: 8 fullname: 田村 遵一 – sequence: 9 fullname: Oshima Kiyohiro |
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| DocumentTitleAlternate | Sepsis Caused by Colonic Diverticulitis with no Abdominal Signs and Symptoms: Report of a Case |
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| References | 6) Andeweg CS, Mulder IM, Felt-Bersma RJF: Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis. Dig Surg 2013; 30: 278-292. 16) Falidas E, Anyfantakis G, Boutzouvis S, et al: Recurrent Urinary Tract Infections due to Asymptomatic Colonic Diverticulitis. Case Rep Med 2012; 2012: 934168. 1) Dellinger RP, Levy MM, Rhodes A, et al; Surviving Sepsis Campaign：international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013; 39: 165-228. 18) Cadranel JF, Nousbaum JB, Bessaguet C, et al: Low incidence of spontaneous bacterial peritonitis in asymptomatic cirrhotic outpatients. World J Hepatol 2013; 5: 104-108. 2) Barkhausen J, Stoblen F, Dominguez FE, et al: Impact of CT in patients with sepsis of unknown origin. Acta Radiol 1999; 40: 552-555. 3) Pien BC, Sundaram P, Raoof N, et al: The clinical and prognostic importance of positive blood cultures in adults. Am J Med 2010; 123: 819-828. 10) AV Weizman, GC Nguyen: Diverticular disease: Epidemiology and management. Can J Gastroenterol 2011; 25: 385-389. 15) Fehmer T, Citak M, Schildhauer TA: Sigmoido-gluteal fistula-a rare complication in clinically asymptomatic chronic diverticulitis. Acta Chir Belg 2011; 11: 232-235. 4) Stollman N, Raskin JB: Diverticular disease of the colon. The Lancet 2004; 363: 631-639. 13) Sethbhakdi S: Pathogenesis of colonic diverticulitis and diverticulosis. Postgrad Med 1976; 60: 76-81. 17) Petro M, Minocha A: Asymptomatic early acute appendicitis initiated and diagnosed during colonoscopy: a case report. World J Gastroenterol 2005; 11: 5398-5400. 12) Susumu Toda, Yasuhiko Ito, Masashi Mizuno, et al: Asymptomati diverticulosis identified by computed tomography is not a risk factor for enteric peritonitis. Nephrol Dial Transplant 2012; 27: 2511-2516. 8) Liljegren G, Chabok A, Wickborn M, et al: Acute colonic diverticulitis: a systematic review of diagnostic accuracy. Colorectal Dis 2007; 9: 480-488. 5) Morris J, Stellato TA, Lieberman J, et al: The utility of computed tomography in colonic diverticulitis. Ann Surg 1986; 204: 128-132. 7) Klarenbeek BR, de Korte N, van der Peet DL: Review of current classifications for diverticular disease and a translation into clinical practice. Int J Colorectal Dis 2012; 27: 207-214. 14) Jonanovic P, Zerem E, Zildzic M: Management of liver abscess formed after asymptomatic sigmoid diverticulitis. Med Arh 2007; 61: 117-118. 9) Mizuki A, Nagata H, Tatemichi M, et al: The out-patient management of patients with acute mild-to-moderate colonic diverculitis. Aliment Pharmacol Ther 2005; 21: 889-897. 11) Holly S, Dustin L: Diverticular Disease: Diagnosis and Treatment. Am Fam Physician 2005; 72: 1229-1234. |
| References_xml | – reference: 16) Falidas E, Anyfantakis G, Boutzouvis S, et al: Recurrent Urinary Tract Infections due to Asymptomatic Colonic Diverticulitis. Case Rep Med 2012; 2012: 934168. – reference: 5) Morris J, Stellato TA, Lieberman J, et al: The utility of computed tomography in colonic diverticulitis. Ann Surg 1986; 204: 128-132. – reference: 12) Susumu Toda, Yasuhiko Ito, Masashi Mizuno, et al: Asymptomati diverticulosis identified by computed tomography is not a risk factor for enteric peritonitis. Nephrol Dial Transplant 2012; 27: 2511-2516. – reference: 8) Liljegren G, Chabok A, Wickborn M, et al: Acute colonic diverticulitis: a systematic review of diagnostic accuracy. Colorectal Dis 2007; 9: 480-488. – reference: 7) Klarenbeek BR, de Korte N, van der Peet DL: Review of current classifications for diverticular disease and a translation into clinical practice. Int J Colorectal Dis 2012; 27: 207-214. – reference: 10) AV Weizman, GC Nguyen: Diverticular disease: Epidemiology and management. Can J Gastroenterol 2011; 25: 385-389. – reference: 18) Cadranel JF, Nousbaum JB, Bessaguet C, et al: Low incidence of spontaneous bacterial peritonitis in asymptomatic cirrhotic outpatients. World J Hepatol 2013; 5: 104-108. – reference: 17) Petro M, Minocha A: Asymptomatic early acute appendicitis initiated and diagnosed during colonoscopy: a case report. World J Gastroenterol 2005; 11: 5398-5400. – reference: 14) Jonanovic P, Zerem E, Zildzic M: Management of liver abscess formed after asymptomatic sigmoid diverticulitis. Med Arh 2007; 61: 117-118. – reference: 9) Mizuki A, Nagata H, Tatemichi M, et al: The out-patient management of patients with acute mild-to-moderate colonic diverculitis. Aliment Pharmacol Ther 2005; 21: 889-897. – reference: 13) Sethbhakdi S: Pathogenesis of colonic diverticulitis and diverticulosis. Postgrad Med 1976; 60: 76-81. – reference: 4) Stollman N, Raskin JB: Diverticular disease of the colon. The Lancet 2004; 363: 631-639. – reference: 3) Pien BC, Sundaram P, Raoof N, et al: The clinical and prognostic importance of positive blood cultures in adults. Am J Med 2010; 123: 819-828. – reference: 1) Dellinger RP, Levy MM, Rhodes A, et al; Surviving Sepsis Campaign：international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013; 39: 165-228. – reference: 11) Holly S, Dustin L: Diverticular Disease: Diagnosis and Treatment. Am Fam Physician 2005; 72: 1229-1234. – reference: 2) Barkhausen J, Stoblen F, Dominguez FE, et al: Impact of CT in patients with sepsis of unknown origin. Acta Radiol 1999; 40: 552-555. – reference: 15) Fehmer T, Citak M, Schildhauer TA: Sigmoido-gluteal fistula-a rare complication in clinically asymptomatic chronic diverticulitis. Acta Chir Belg 2011; 11: 232-235. – reference: 6) Andeweg CS, Mulder IM, Felt-Bersma RJF: Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis. Dig Surg 2013; 30: 278-292. |
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| Snippet | 症例は62歳男性。意識障害を主訴に当院搬送された。来院時Glasgow coma scale10 （E3V3M4）の意識障害を認めるとともに，バイタルサインは体温40.8℃，心拍数140回/分，呼吸... A 62-year-old male with disturbance of consciousness was transferred to our emergency room. On arrival, his Glasgow coma scale was 10 points, heart rate was... |
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| SubjectTerms | 大腸憩室炎 敗血症 |
| Title | 腹部症候を伴わない上行結腸憩室炎から敗血症に至ったと考えられた1例 |
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