巨大直腸内異物除去に有用であった腹腔鏡補助下手術の1例

Successful extraction of a giant foreign body in the rectum using laparoscopy-assisted surgery : a case report

◆要旨：患者は56歳，男性．肛門よりロウソクを挿入し，腹痛にて受診し入院となった．腹部CTにて直径65mm×長さ150mmの直腸内異物を確認した．大腸内視鏡検査にて直腸Raに異物の肛門側端を認めたが除去不可能であり，経肛門イレウス管を異物の口側に挿入して減圧した．腰椎麻酔下での経肛門的摘出を試みたが不可能であった．経肛門イレウス管の挿入により内服による腸管洗浄が可能であった．3日後，腹腔鏡下に小切開を置き，術者の右手を腹腔内に挿入し，用手的圧迫により経肛門的に異物を除去し得た．腹腔鏡補助下手術は腸管を詳細に観察でき，かつ最小の創で的確な手術が可能であり，非観血的に除去不可能な巨大直腸内異物に対しても非常に有用であった．

　A 56-year-old man who had inserted a candle into his own anus, was admitted to our hospital with a complaint of abdominal pain. On abdominal CT, the foreign body was found to measure 65 mm in diameter and 150 mm in length. Colonoscopy detected the anal side end of the foreign body in the rectum（Ra）, but removal was not possible in the dispensary. A transanal ileus tube was inserted to the oral side of the foreign body to avoid colon ileus. Transanal extraction was attempted under lumbar anesthesia, but it was not possible. Oral intestinal lavage was possible via the transanal ileus tube. After 3 days, a small incision was made in the lower abdomen under laparoscopy, and the operator inserted his right hand into the abdominal cavity and manually compressed the foreign body, after which the foreign body could be removed per anum. Laparoscopy allowed detailed observation of the intestine and enabled accurate surgery through the smallest incision. The procedure was very useful for the removal of a giant foreign body in the rectum, for which non-invasive removal was otherwise not possible.