人工肛門造設後9年目に発症したS状結腸膀胱瘻

VESICOSIGMOIDAL FISTULA DEVELOPING NINE YEARS AFTER CONSTRUCTION OF SIGMOIDCOLOSTOMY

　75歳，女性．糞尿を主訴として受診した．66歳時Miles手術の既往があり，ストーマからの注腸造影でS状結腸膀胱瘻が証明され，瘻孔部からストーマまでのS状結腸切除，膀胱部分切除およびストーマ再造設術を施行した．病理組織学的には炎症性で，臨床的には医原性S状結腸膀胱瘻と考えられた．人工肛門造設後に発症した症例としては本邦第1例目と思われる．

A 75-year-old woman who had undergone the Miles' operation at the age of 66 complained of fecaluria. Barium enema into sigmoidcolostomy demonstrated a vesicosigmoidal fistula. Laparotomy showed adhesion of a sigmoid loop to the bladder dome. The bladder was partially excised. The sigmoid colon distal to the fistula was resected and the stoma was reconstracted. Histologically the excised fistula showed inflammma-tion. An intrapelvic abscess that had developed after the Miles' operation may have caused the fistula. This patient is the first case of vesicosigmoidal fistula developing after construction of sigmoidcolostomy in Japan.