藤村 二郎¹, 真田 泰興¹, 鈴木 重道¹, 桑田 幸央¹, 井上 和彦¹, 坂之上 一史¹, 香川 幸司¹, 菅沢 一子², 伊原 恵子², 多久和 小百合²

Jiro FUJIMURA¹, Yasuoki SANADA¹, Shigemichi SUZUKI¹, Yukio KUWATA¹, Kazuhiko INOUE¹, Kazufumi SAKANOUE¹, Koji KAGAWA¹, Kazuko SUGESAWA², Keiko IHARA², Sayuri TAKUWA²

¹松江赤十字病院内科, ²松江赤十字病院検査部腹部超音波検査室

¹Department of Internal Medicine, Matsue Red Cross Hospital, 2000 Horo-machi, Matsue-shi, Shimane-ken 690-0886, Japan, ²Division of Abdominal Ultrasound, Matsue Red Cross Hospital, 2000 Horo-machi, Matsue-shi, Shimane-ken 690-0886, Japan

キーワード : Computed tomography, Fish bone, Ultrasonography

Preoperative diagnosis in the perforation or penetration of the digestive tract by an ingested fish bone is very difficult. A case of inflammatory granuloma in the ileocecal region caused by penetration by a fish bone, diagnosed by ultrasonography (US), and computed tomography (CT) is reported here. A 64-year-old man was seen at this institution because of sudden onset of right lower abdominal pain. Tenderness and muscle defense were present on the right lower quadrant of the abdomen. White blood-cell count was 14,100/mm³, and CRP was 21.2 mg/dl. US examination showed a linear hyperechoic region inside a hypoechoic mass. CT showed a well-defined linear high-density fish bone inside a low-density mass (5×3 cm). The diagnosis was inflammatory granuloma caused by penetration by a fish bone, and surgery was performed. The 3.5-cm bone was found near the perforated region of the appendix during surgery. A diagnosis of inflammatory granuloma resulting from penetration to the appendix by a fish bone was made. This case demonstrates that US examination is effective in preoperative diagnosis.