腹腔鏡下腹会陰式直腸切断術後に温存した左結腸動脈により腸閉塞をきたした1例

A case of an intestinal obstruction after laparoscopic abdominoperineal resection due to the preserved left colic artery

◆要旨：患者は52歳，男性．直腸癌に対して腹腔鏡下腹会陰式直腸切断術を施行した際，左結腸動脈は温存しながらD3郭清し，下行結腸で人工肛門を造設した．術後27日目に腸閉塞となり，保存的な加療では改善しないために開腹手術を行った．空腸の一部が左結腸動脈と下行結腸の間に嵌入し閉塞しており，左結腸動脈はすでに拍動がなかったため，切離し腸閉塞を解除した．

　自験例は当初，超低位前方切除を念頭に左結腸動脈を温存していたが，そのまま前腹壁に挙上し人工肛門を造設したため，内ヘルニアが起こりやすい状態になったと考えられた．腹腔鏡下手術において左結腸動脈を温存する術式で，人工肛門を造設する場合には注意する必要があると考えた．

　We report a case of postoperative intestinal obstruction after laparoscopic abdominoperineal resection（AP-R）due to the preserved left colic artery. A 52-year-old male underwent laparoscopic AP-R for rectal cancer which had been found due to anal bleeding. The patient readmitted due to intestinal obstruction after 27 days of the first operation. Laparotomy was performed and the ileum was found to be trapped between the left colic artery and mesocolon and obstructed. The left colic artery was cut and the ileum was released.

　The left colic artery was preserved at the first operation to assure good blood flow to the descending colon, but it assumed this position to cause this rare complication when the colostomy was made. Although the preservation of the left colic artery is routine for rectal cancer operation, the indication should be thoroughly considered.