卵巣穿通を伴ったS状結腸憩室炎に対し腹腔鏡下S状結腸切除術を施行した1例

A case of diverticulitis with tuboovarian abscess resected by laparoscopic surgery

◆要旨：患者は66歳，女性．歩行時の心窩部痛を主訴に外科を受診した．CT検査所見ではS状結腸憩室炎，腫大した左卵巣内に液体貯留とガス像を認め，上腹部と骨盤腔内に大量のfree airを伴っていた．以上の所見より，S状結腸憩室の卵巣穿通と診断し，緊急で腹腔鏡下S状結腸切除術，左卵巣合併切除を施行した．S状結腸には憩室を認め，腸管壁肥厚を伴っていた．S状結腸憩室と左卵巣が高度に癒着しており，術中卵巣内からairの流出を認め，卵巣穿通を伴うS状結腸憩室穿孔と診断した．術後縫合不全などはなく，術後17日目に退院した．卵巣穿通を伴うS状結腸憩室炎の報告は非常に稀であるため，報告する．

　A 66-year-old woman with upper abdominal pain induced by walking was referred to our department. Computed tomography showed free intraperitoneal air and an oval shaped tumor adjacent to the diverticulitis of sigmoid colon. Laparoscopic surgery was performed urgently under the preoperative diagnosis of sigmoid colon perforation. Intraoperatively, a flow of air from left swollen ovary suggested perforation from diverticulitis to left ovary. There was very little ascites, so laparoscopic sigmoidectomy was performed. Left ovary adhered to sigmoid colon was resected at the same time. The patient was discharged 17 days after surgery. Histological diagnosis was diverticulitis with tuboovarian abscess. There have been only few reported cases of diverticulitis with tuboovarian abscess treated by laparoscopic sigmoidectomy.