直腸内異物挿入による直腸穿孔に対して腹腔鏡下手術を施行した1例

A case of laparoscopic surgery for rectal perforation by a transanal foreign body

◆要旨：患者は36歳，男性．肛門から鉛筆を挿入した3日後の排便直後に突然腹痛をきたし，救急搬送された．身体所見と画像所見より直腸内異物による直腸穿孔と診断し，腹腔鏡下で緊急手術を施行した．鉛筆は直腸壁を貫通し，腹腔内へ突出していた．大腸内視鏡により鉛筆を経肛門的に抜去し，穿孔部は腹腔鏡下で縫合閉鎖した．術後の経過は良好で，術後17病日に退院となった．

　大部分の下部消化管穿孔は開腹下で手術を施行されているが，状況によっては腹腔鏡下手術でも十分対処可能で，また，術中大腸内視鏡検査の併用は，異物の誘導や穿孔部の確認ができることから有用な方法であると考えられた．

　A 36-year-old male was referred to our hospital in an emergency because of sudden abdominal pain immediately after defecation on 3 days after pencil insertion into the rectum by the transanal route. Physical examination and radiologic imaging test led to a diagnosis of rectal perforation with peritonitis due to a foreign body in the rectum. An emergency operation was performed laparoscopically. The pencil had penetrated the rectal wall into the abdominal cavity. The pencil was removed using a colonoscopical procedure, and the perforated site was sutured and closed laparoscopically. Postoperative course was uneventful and he was discharged on postoperative day 17.

Though almost of colorectal perforation are treated by laparotomy, laparoscopic operation is also possible depending on the patient's status. Intraoperative colonoscopy is a useful combination as it enables the derivation of the foreign body and the perforated site confirmation.