腹腔鏡補助下S状結腸切除術後に吻合部肛門側腸管の虚血を生じた1例

Ischemic necrosis of anastomotic intestine at anal side after laparoscopic-assisted sigmoid colectomy : A case report

◆要旨：今回筆者らはS状結腸癌に対して腹腔鏡補助下S状結腸切除術を行い，吻合部肛門側腸管の虚血による縫合不全を認めた症例を経験したので報告する．患者は慢性腎不全で維持透析中の70歳男性．S状結腸癌に対して腹腔鏡補助下S状結腸切除術，D2郭清を施行した．術後1日目の透析中に頻脈，悪寒戦慄，腹痛が出現したため縫合不全を疑い臨時手術の方針となり，術中所見において下腸間膜動脈の閉塞と吻合部肛門側腸管の虚血壊死を認め，Hartmann手術を施行した．動脈硬化性病変を有する症例でのSD junction近傍の病変に対する手術の際には，直腸S状結腸移行部での辺縁動脈の吻合の欠損の可能性を考慮した血管処理術式であっても肛門側腸管の血流不全発症の可能性があり，それも見据えた手術計画を要すると考えられた．

　A 70-year-old man on maintenance hemodialysis underwent laparoscopic-assisted sigmoid colectomy with D2 dissection for sigmoid colon cancer. On postoperative day 1, tachycardia, shivering and abdominal pain occurred during dialysis. Because postoperative anastomotic failure was suspected, operation was performed. Intraoperative findings revealed occlusion of the inferior mesenteric artery and ischemic necrosis of the anastomotic intestine at the anal side. Hartmann's operation was performed. For patient with atherosclerotic changes whose surgical lesion is near the sigmoid-descending colon junction, even though careful surgical plan including the possibility of a defect in marginal artery in rectosigmoid lesion is made, the possibility of blood flow failure in anastomotic intestine should also be noted.