内視鏡的整復後，待機的に単孔式腹腔鏡補助下S状結腸切除術を施行したS状結腸軸捻転症の1例

Single-incision laparoscopy-assisted sigmoid colectomy following endoscopic decompression for sigmoid volvulus : a case report

◆要旨：患者は65歳，女性．1か月前にS状結腸軸捻転症に対する内視鏡的整復の既往がある．腹部膨満感を主訴に外来を受診した．腹部全体の著明な膨満を認め，腹部単純X線および腹部CTからS状結腸軸捻転症再発と診断し，内視鏡的整復術を施行した．内視鏡的整復から12日目に単孔式腹腔鏡補助下S状結腸切除術を施行した．手術直前に内視鏡を用いて腸管内容を吸引し，良好な視野展開を得た．術後経過は良好で，術後10日目に軽快退院した．血流障害を伴わないS状結腸軸捻転症に対しては，内視鏡的整復後の待機的な単孔式腹腔鏡補助下S状結腸切除術が，低侵襲かつ安全な治療の選択肢の1つになりうると考えた．

We experienced a patient with sigmoid volvulus who was treated with single-incision laparoscopy-assisted sigmoid colectomy after endoscopic decompression. The patient, a 65-year-old woman, presented with abdominal distension. Physical examination, plain abdominal X-ray and enhanced computed tomography indicated a sigmoid volvulus. Endoscopic detorsion was performed successfully. The attack of sigmoid volvulus was the second episode for her. Single-incision laparoscopic sigmoidectomy was performed 12 days after the endoscopic detorsion. The involved sigmoid colon was totally mobilized by a laparoscopic medial-to-lateral dissection sequence, after which it was exteriorized, transected, and reconstructed by functional end-to-end anastomosis. The postoperative course was uneventful and the patient was discharged from our hospital 10 days after the operation. Our experience indicates that single-incision laparoscopy-assisted sigmoid colectomy after a successful colonoscopic decompression is safe and feasible for patients with sigmoid volvulus.