腸管子宮内膜症に対する腹腔鏡補助下大腸切除術の1例

A case of bowel endometriosis operated laparoscopically

◆要旨：腸管子宮内膜症に対して腹腔鏡下に手術を施行した症例を経験したので報告する．患者は38歳，女性．主訴は排便困難，排便時痛で，近医で大腸内視鏡検査を施行した．全周性の直腸狭窄を認め，精査目的で当科受診となった．注腸検査，骨盤MRI検査では，直腸Raに約4cmにわたる全周性の狭窄を認めた．内視鏡検査による生検結果では子宮内膜組織を認めなかったが，腸管子宮内膜症と診断し，ホルモン治療（6か月）を施行後に手術（腹腔鏡下低位前方切除，癒着剝離術）を施行した．病理所見では，直腸の漿膜から粘膜下層に子宮内膜腺が異所性に増殖し，内膜腺周囲に線維化像を認めた．術後経過は良好で第17病日目に退院し，現在まで再燃や再発は認めていない．

　We report a case of bowel endometriosis operated laparoscopically. A 38-year-old woman with difficulty and pain of defecation was referred to our hospital due to circumferential stenosis in the rectum found by colonoscopic examination. Barium enema and pelvic MRI studies confirmed circumferential stenosis approximately 4 cm in length in the upper part of the rectum（Ra）. Rectal biopsy revealed no endometrial tissue. With the diagnosis of rectal endometriosis, hormonal therapy was started, followed by surgical treatment six month later. Low anterior resection of the rectum and adhesiolysis were carried out. Pathological examination of the specimen revealed ectopic proliferation of endometrial glandular tissue in the rectal wall from the submucosa to the serosa, with some fibrotic changes in the periphery. The patient was discharged from the hospital on Day 17. The post-operative course has been uneventful till today with no recurrence of symptoms at all.