内視鏡的整復後待期的に腹腔鏡補助下結腸切除術を行ったS状結腸軸捻転症の1例

A case of recurrent sigmoid volvulus treated by laparoscope assisted sigmoidectomy following endoscopic decompression

◆要旨：患者は71歳の男性．腹部膨満感と腹痛を主訴に外来を受診し，腹部全体の著明な膨隆を認めた．腹部X線検査でcoffee bean signを認めた．腹部CT検査ではS状結腸は著明に拡張し，結腸間膜内にwhirl signを認め，S状結腸軸捻転症と診断した．緊急大腸内視鏡検査を行い，内視鏡下に捻転整復した．患者に十分説明同意のうえ腹腔鏡補助下S状結腸切除術を行った．S状結腸を約30cm切除，結腸が直線化するように配慮して再建を行った．術後経過は良好で，術後9日目に軽快退院した．S状結腸軸捻転症に対して内視鏡的整復後待機的に腹腔鏡補助下切除術を行い良好な結果を得た症例を経験したので文献的考察を加えて報告する．

　Recently, we experienced a case of sigmoid volvulus that was successfully treated by laparoscope assisted sigmoidectomy after endoscopic decompression. The patient, a 71-year-old Japanese man, presented with abdominal pain and distension. Physical examination, plain abdominal X-ray, enhanced computed tomography（CT）and gastrografin-enema indicated a sigmoid volvulus. Colonoscopic examination showed an obstructive recto-sigmoid junction and unusually distended sigmoid colon at 20 cm from the anal verge. The abdominal distension was reduced by suction of the air and feces by using colonoscopy. Laparoscope assisted sigmoidectomy was performed following successful endoscopic detorsion. The postoperative course was uneventful and the patient was discharged from our hospital 9 days after operation. This case is a demonstration of the effectiveness of the laparoscope assisted colectomy for sigma volvulus. We report a case of sigmoid volvulus treated by laparoscope assisted sigmoidectomy following endscopic reduction with review of the literature.