回盲部単純性潰瘍の術後再々発に対し再度腹腔鏡補助下手術を行った1例

Laparoscopic surgery for post-operative relapses of simple ileocecal ulcer

◆要旨：患者は50歳，女性．2001年の健診で便潜血反応陽性を指摘され，大腸内視鏡検査で回盲部Bauhin 弁に潰瘍を認めた．以後，増悪と寛解を繰り返し，2005年2月腹腔鏡補助下回盲部切除・端々吻合再建を施行し，さらに再発したため，2006年11月腹腔鏡補助下結腸右半切除・端々層々吻合を施行した．2008年12月以降炎症反応の高値が持続し，吻合部潰瘍と腫瘤性病変を認めたため，2012年5月腹腔鏡補助下回結腸部分切除を施行した．病理結果は，吻合部のUl-IVの潰瘍で，腫瘤は小動脈壁の肥厚であった．本疾患は再発予防に確実な治療がなく，再発率も高い．今後も予想される再発時の手術に際し，腹腔鏡下手術は癒着や腹壁破壊を最小限にすることができ，きわめて有用である．

The patient is a 50 years old woman. Routine physical checkup revealed positive fecal occult blood test in 2001 and colon fiberscope showed an ulcer in the Bauhin valve. Despite various treatments, the ulcer recurred and laparoscopic resection of ileocecum was performed with end to end anastomosis. Pathological diagnosis was simple ulcer. The patient was well after the surgery, but she soon complained of abdominal pain. The ulcer relapsed at the colon side of anastomotic site. Diet treatment with central venous nutrition was performed but the ulcer did not improve. Right hemicolectomy was performed. Pathology revealed similar simple ulcer at the colon side of anastomotic site. In 2008, the ulcer relapsed. The patient had conservative medical treatment but high inflammatory response continued. Ulcer of the anastomotic site and a mass lesion were noted, so part of the ileocecum was resected laparoscopically. The lesion was simple ulcer and hypertrophy of small arterial wall. Simple ulcer has no effective treatment, and recurs frequently. Laparoscopic operation is useful because it minimizes adhesion and abdominal wall destruction.