直腸損傷を伴った開放性骨盤骨折の1例
It is well known that a severe pelvic fracture with perineal injury might be complicated by various infections, especially occurring in perineal areas, following critical sepsis. We have saved a patient suffering from an open-book type pelvic fracture with rectal injury and broad perineal laceration...
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| Published in | Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 36; no. 1; pp. 173 - 176 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本腹部救急医学会
2016
Japanese Society for Abdominal Emergency Medicine |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem.36.173 |
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| Abstract | It is well known that a severe pelvic fracture with perineal injury might be complicated by various infections, especially occurring in perineal areas, following critical sepsis. We have saved a patient suffering from an open-book type pelvic fracture with rectal injury and broad perineal laceration, traumatic brain injury, and chest trauma, as we performed damage control strategy. In particular, we used a commercially available anal catheter as a fecal diversion for the prevention of perineal infection. We suggest that this catheter diversion method is very easy as well as highly effective for the prevention of perineal infection after severe pelvic trauma.
開放性骨盤骨折は出血や骨盤内深部感染症を引き起こし，高い死亡率を示す重症外傷の一つである。われわれは，墜落外傷による他臓器損傷と出血性ショックを伴った開放性骨盤骨折に対し，ダメージコントロール手術を実施し，fecal diversionとして人工肛門造設と直腸用カテーテルを併用し深部感染予防に対処し救命し得た1例を経験したので報告する。 |
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| AbstractList | It is well known that a severe pelvic fracture with perineal injury might be complicated by various infections, especially occurring in perineal areas, following critical sepsis. We have saved a patient suffering from an open-book type pelvic fracture with rectal injury and broad perineal laceration, traumatic brain injury, and chest trauma, as we performed damage control strategy. In particular, we used a commercially available anal catheter as a fecal diversion for the prevention of perineal infection. We suggest that this catheter diversion method is very easy as well as highly effective for the prevention of perineal infection after severe pelvic trauma.
開放性骨盤骨折は出血や骨盤内深部感染症を引き起こし，高い死亡率を示す重症外傷の一つである。われわれは，墜落外傷による他臓器損傷と出血性ショックを伴った開放性骨盤骨折に対し，ダメージコントロール手術を実施し，fecal diversionとして人工肛門造設と直腸用カテーテルを併用し深部感染予防に対処し救命し得た1例を経験したので報告する。 開放性骨盤骨折は出血や骨盤内深部感染症を引き起こし，高い死亡率を示す重症外傷の一つである。われわれは，墜落外傷による他臓器損傷と出血性ショックを伴った開放性骨盤骨折に対し，ダメージコントロール手術を実施し，fecal diversionとして人工肛門造設と直腸用カテーテルを併用し深部感染予防に対処し救命し得た1例を経験したので報告する。 |
| Author | 中沼, 寛明 古城, 都 西中, 徳治 村田, 厚夫 三宅, 亮 |
| Author_FL | Nishinaka Tokuji Kojyou Miyako Nakanuma Hiroaki Miyake Tasuku Murata Atsuo |
| Author_FL_xml | – sequence: 1 fullname: Miyake Tasuku – sequence: 2 fullname: Murata Atsuo – sequence: 3 fullname: Nakanuma Hiroaki – sequence: 4 fullname: Kojyou Miyako – sequence: 5 fullname: Nishinaka Tokuji |
| Author_xml | – sequence: 1 fullname: 村田, 厚夫 organization: 健和会大手町病院救急科 – sequence: 1 fullname: 古城, 都 organization: 健和会大手町病院外科 – sequence: 1 fullname: 三宅, 亮 organization: 健和会大手町病院外科 – sequence: 1 fullname: 西中, 徳治 organization: 健和会大手町病院救急科 – sequence: 1 fullname: 中沼, 寛明 organization: 健和会大手町病院外科 |
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| Copyright | 2014, Japanese Society for Abdominal Emargency Medicine |
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| References | 12) 爲廣一仁，靍 知光，黒田久志，ほか：直腸用カテーテル（フレキシシールⓇ）を使用し人工肛門を造設せずに治療を行うことができたFournier壊疽の1例．日腹部救急医会誌2014；34：895-898 1) Cannada LK, Taylor RM, Reddix R, et al: The Jones-Powell Classification of open pelvic fractures: a multicenter study evaluating mortality rates. J Trauma Acute Care Surg 2013; 74: 901-906. 9) Keshava A, Renwick A, Stewart P, et al: A nonsurgical means of fecal diversion: The Zassi Bowel Management System. Dis Colon Rectum 2007; 50: 1017-1022. 11) 東真理子：坐骨部の褥瘡にアクチフロー排便留置カテーテルを使用した一症例．関西STOMA研究会2012；54：11 3) Mylankal KJ, Wyatt MG: Control of major haemorrhage and damage control surgery. Surgery（Oxford）2013; 31, 574-581. 7) Mossadegh S, Tai M, Midwinter M, et al: Improvised explosive device related pelvi-perineal trauma: anatomic injuries and surgical management. J Trauma Acute Care Surg 2012; 73: S24-S31. 6) Brenneman FD, Katyal D, Boulanger BR, et al: Long-term outcomes in open pelvic fractures. J Trauma 1997; 42: 773-777. 2) Rotondo MF, Schwab CW, McGonigal MD, et al: “Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 1993; 35: 375-382. 5) Jones AL, Powell JN, Kellam JF, et al: Open pelvic fractures. A multicenter retrospective analysis. Orthop Clin North Am 1997; 28: 345-350. 10) Bordes J, Goutorbe P, Asencio Y, et al: A non-surgical device for faecal diversion in the management of perineal burns. Burns 2008; 34: 840-844. 13) Lunsjo K, Abu-Zidan FM: Does colostomy prevent infection in open blunt pelvic fractures? A systematic review. J Trauma 2006; 60: 1145-1148. 4) 日本外傷学会臓器損傷分類委員会：骨盤損傷分類2008（日本外傷学会）．日外傷会誌 2008；45 8) Beekley AC: Damage control resuscitation: a sensible approach to the exsanguinating surgical patient. Crit Care Med 2008; 36: S267-274. |
| References_xml | – reference: 2) Rotondo MF, Schwab CW, McGonigal MD, et al: “Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 1993; 35: 375-382. – reference: 11) 東真理子：坐骨部の褥瘡にアクチフロー排便留置カテーテルを使用した一症例．関西STOMA研究会2012；54：11． – reference: 7) Mossadegh S, Tai M, Midwinter M, et al: Improvised explosive device related pelvi-perineal trauma: anatomic injuries and surgical management. J Trauma Acute Care Surg 2012; 73: S24-S31. – reference: 12) 爲廣一仁，靍 知光，黒田久志，ほか：直腸用カテーテル（フレキシシールⓇ）を使用し人工肛門を造設せずに治療を行うことができたFournier壊疽の1例．日腹部救急医会誌2014；34：895-898． – reference: 10) Bordes J, Goutorbe P, Asencio Y, et al: A non-surgical device for faecal diversion in the management of perineal burns. Burns 2008; 34: 840-844. – reference: 1) Cannada LK, Taylor RM, Reddix R, et al: The Jones-Powell Classification of open pelvic fractures: a multicenter study evaluating mortality rates. J Trauma Acute Care Surg 2013; 74: 901-906. – reference: 9) Keshava A, Renwick A, Stewart P, et al: A nonsurgical means of fecal diversion: The Zassi Bowel Management System. Dis Colon Rectum 2007; 50: 1017-1022. – reference: 3) Mylankal KJ, Wyatt MG: Control of major haemorrhage and damage control surgery. Surgery（Oxford）2013; 31, 574-581. – reference: 6) Brenneman FD, Katyal D, Boulanger BR, et al: Long-term outcomes in open pelvic fractures. J Trauma 1997; 42: 773-777. – reference: 4) 日本外傷学会臓器損傷分類委員会：骨盤損傷分類2008（日本外傷学会）．日外傷会誌 2008；45． – reference: 13) Lunsjo K, Abu-Zidan FM: Does colostomy prevent infection in open blunt pelvic fractures? A systematic review. J Trauma 2006; 60: 1145-1148. – reference: 5) Jones AL, Powell JN, Kellam JF, et al: Open pelvic fractures. A multicenter retrospective analysis. Orthop Clin North Am 1997; 28: 345-350. – reference: 8) Beekley AC: Damage control resuscitation: a sensible approach to the exsanguinating surgical patient. Crit Care Med 2008; 36: S267-274. |
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| Snippet | 開放性骨盤骨折は出血や骨盤内深部感染症を引き起こし，高い死亡率を示す重症外傷の一つである。われわれは，墜落外傷による他臓器損傷と出血性ショックを伴った開放性骨盤... It is well known that a severe pelvic fracture with perineal injury might be complicated by various infections, especially occurring in perineal areas,... |
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| Title | 直腸損傷を伴った開放性骨盤骨折の1例 |
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