完全内臓逆位症に合併した完全直腸脱に対し腹腔鏡下直腸固定術を施行した1例

Laparoscopic proctopexy for patient associated with situs inversus totalis

完全内臓逆位を合併した完全直腸脱に対し腹腔鏡下直腸固定術を施行した．症例は62歳，女性．脱出と還納を繰り返す肛門部腫瘤を主訴に近医を受診し,完全直腸脱の診断で当院に紹介となった．既往歴は，完全内臓逆位，リウマチによる変形性膝関節症，糖尿病であった．術式は腹腔鏡下直腸固定術とし，臍部，左右側腹部に2か所ずつ，計5か所にトロッカーを挿入し，すべて12mmで行った．完全内臓逆位のため通常の位置より左右を変更し,手術は安全に行うことが可能であった．

　We report a patient with a complete situs inversus totalis who underwent laparoscopic proctopexy. A 65-year-old woman had complained of anal tumor that repeatedly prolapsed and repositioned for one month. She was diagnosed as having a rectal prolapse and was referred to our hospital. Her history included a complete situs inversus totalis, knee osteoarthritis due to rheumatism and diabetes mellitus. Rectopexy was performed laparoscopically using five trocars : a 12 mm umbilical trocar, two left flank and two right flank trocars. The procedure as performed safely changing right-and-left position because of complete situs inversus totalis.