注腸造影後排便があり，その後にCT検査が施行された．図１３の直腸1から逆行性に下部結腸を追跡すると容易に図２のS状結腸下行結腸移行部16に到達する．排便後だから空虚となっており，直腸とS状結腸が全長に亘って壁肥厚（5mm以上）しているといえる．ガストログラフィン注入後のCTだから，図３〜図７で憩室（↑）が造影されて明白に認識できる．図３〜図９の△はガスと，造影剤を含む液状物質でニボーを形成し，頭側は図３で，尾側は図１１で盲端になるので腸管ではなく，膿瘍である．造影剤は結腸から漏れたものであり，膿瘍はS状結腸と隣接し，Ｓ状結腸に憩室があり，S状結腸壁の肥厚を認めるのでS状結腸憩室炎穿孔による膿瘍と診断する．図１の直腸S状結腸造影にて数個の憩室（▲）と，膿瘍内のガス像（白矢印）を認めるが，造影剤の漏出は認識できずS状結腸穿孔の診断は出来なかった．このように直腸・S状結腸の穿孔例で，ガストログラフィン注入後のCT検査は極めて有用である．経腟的に穿刺し膿を認め（図A），経腟的ドレナージを施行し治癒した．

文献考察：徳洲会グループでは骨盤腔膿瘍の治療に開腹されている症例が多い、経直腸的または経腟的ドレナージをもっと応用すべき
１）Hovsepian DM.
Transrectal and transvaginal abscess drainage.　
J Vasc Interv Radiol. 1997 Jul-Aug;8(4):501-15. 　
　The TR and TV approaches to deep pelvic abscesses have been made safe and easy　by improvements in endoluminal US technology. Most procedures take well under an　hour, and standard intravenous sedation is usually sufficient for patient　comfort. The simplest and safest technique employs a combination of endoluminal　US, with biopsy guides for precision needle advancement, and fluoroscopy for　dilating the tract and placing a drainage catheter. Patient acceptance of TR and　TV catheters is high, and resolution can typically be expected within 3-5 days.　In the majority of cases, catheter treatment, combined with antibiotic therapy, is curative.　　　　　PMID: 9232564 [PubMed - indexed for MEDLINE]

２）Hovsepian DM, Steele JR, Skinner CS, Malden ES.
Transrectal versus transvaginal abscess drainage: survey of patient tolerance and effect on activities of daily living.
Radiology. 1999 Jul;212(1):159-63.
　PURPOSE: To evaluate patient perception of pain related to transrectal and　transvaginal drainage and the catheter's effect on activities of daily living.　MATERIALS AND METHODS: From July 1993 to August 1997, 22 male and 40 female　patients (mean age, 41 years; age range, 4-80 years) underwent transrectal or　transvaginal aspiration or drainage. Fifty-seven drainages were performed. In a　follow-up survey, patients were asked to score pain experienced during the　procedure and afterward on a scale of 1-10 and to rate the effect of the　catheter on their activities of daily living. RESULTS: Twenty-two patients　participated in the telephone survey. For those able to recall the insertion　procedure, the mean pain score was 3.2 for transrectal and 5.9 for transvaginal　drainage. Mean indwelling catheter pain was 1.6 for transrectal and 4.8 for　transvaginal drainage. Pain after removal was 1.4 for transrectal and 2.3 for　transvaginal drainage. Only one patient with a transrectal catheter reported　severe limitation (bowel movement), with no reports of any serious effect on　urinating, bathing, sitting, or walking. Transvaginally placed catheters caused　marked limitation in all categories and were more painful than transrectal　catheters (P