内科的治療に抵抗性の慢性便秘症に対し腹腔鏡下Frykman-Goldberg手術にて改善しえた1例

A case report of laparoscopic Frykman-Goldberg operation for chronic constipation refractory to medical treatment

◆要旨：患者は63歳，女性．内科的治療に抵抗性の慢性便秘を主訴に当科外来へ紹介となった．排便造影検査にて直腸間膜癒合不全，S状結腸過長症，また怒責時の直腸重積を認めた．症状改善のためには外科的治療が必要と判断し，十分なインフォームドコンセントのうえで腹腔鏡下Frykman-Goldberg手術を施行した．良性疾患かつ創部痛軽減を目的として経肛門的に標本摘出を施行した．現在術後11か月が経過しているが，緩下剤の内服をせず排便は良好であり，また排便造影検査では吻合部の直腸は仙骨に固定され，怒責時の重積を認めていない．内科的治療に抵抗する慢性便秘症例に対しては，原因を同定し外科的治療を行うことで，症状を改善する可能性があると考えられる．

　A 63-year-old woman was referred to our hospital because of chronic constipation refractory to medical treatments. Defecograpfy showed weak fixation to the sacrum, long rectosigmoid and rectal intussusception. Laparoscopic Frykman-Goldberg operation was performed to improve her symptom. For benign disease and reduction of pain, retrieval of specimen was performed by transanal approach. Pseudomembranous enteritis developed, but she was discharged on the nineteenth operation. After the operation, constipation was improved without medical treatment and defecography showed normal movement of defecation. We considered that the operation was feasible for the treatment of chronic constipation refractory to medical treatment.