腰部三角部、腰筋と肋間空間、腰部外転部における膵臓仮性嚢胞の異常な位置

Unusual Locations of Pancreatic Pseudocysts in Lumbar Triangle, Psoas Muscle and Intercostal Space, and Obturator Externus.

• Sanjay Mhalasakant Khaladkar
• Akshay Mahadev Waghmode

抄録

膵仮性嚢胞は急性膵炎と慢性膵炎の両方の合併症として発症する。仮性嚢の一般的な発生部位は小嚢であるが、仮性嚢の拡張は腸間膜、後腹膜、鼠径部、陰嚢、肝臓、脾臓、縦隔、胸膜、肺に発生することがある。仮性嚢胞の腰筋および腰部三角部への進展は極めてまれである。腰三角部への仮性嚢胞の発生は、急性膵炎で臨床的に見られるGrey Turner徴候と放射線学的に同等であり、さらに拡張したものである。この延長は膵酵素の破壊的な性質のために起こる。腰部三角部は、腰部の側腹部壁の解剖学的弱点の部位である。症例は35歳のアルコール依存症男性で，1週間前から腹痛と右腰部の膨張と腫脹を呈していた．腹部のCTスキャンでは，右後副腎腔に多発性の仮性嚢胞を伴う急性-慢性膵炎が検出され，右側腹部壁，右後副腹筋，右腸骨筋，右外反母趾，右上大腿部内側面，上腹部の前腹壁下，右側胸壁に右11肋間腔を介して延長していた．

Pancreatic pseudocyst develops as a complication of both acute and chronic pancreatitis. Although the common location of pseudocyst is lesser sac, extension of pseudocyst can occur into mesentery, retroperitoneum, inguinal region, scrotum, liver, spleen, mediastinum, pleura, and lung. Extension of pseudocyst into psoas muscle and lumbar triangle is extremely rare. The development of pseudocyst in lumbar triangle is radiologically equivalent and further extension of Grey Turner's sign seen clinically in acute pancreatitis. This extension occurs due to the destructive nature of pancreatic enzymes. The lumbar triangle is the site of anatomic weakness in the lateral abdominal wall in the lumbar region. We report the case of a 35-year-old alcoholic male patient who presented with abdominal pain followed by distension and swelling in the right lumbar region for 1 week. On computed tomography scan of the abdomen, acute-on-chronic pancreatitis with multiple pseudocysts in the right posterior pararenal space, extending through the right lumbar triangle in the right lateral abdominal wall, right posterior paraspinal muscles, right iliopsoas, right obturator externus, and medial aspect of the right upper thigh, beneath anterior abdominal wall in the upper abdomen and in the right lateral thoracic wall through the right 11 intercostal space, was detected.