潰瘍性大腸炎術後の残存直腸炎に対し経肛門内視鏡アプローチにより残存直腸切除術を行った1例

A case of proctectomy by transanal endoscopic approach to residual proctitis after total colectomy for ulcerative colitis

◆要旨：潰瘍性大腸炎に対する結腸全摘術後の残存直腸炎に対して，経肛門内視鏡アプローチ単独で残存直腸切除術を行った症例を経験したので報告する．患者は52歳，女性．37歳時に結腸全摘術，回腸人工肛門造設術を施行されたが，残存直腸の炎症が持続し保存的治療で改善しなかったため，残存直腸切除を行う方針とした．骨盤腔内を子宮が占拠していたため，経肛門内視鏡アプローチ単独でも腹腔内の腸管損傷をきたすことなく安全に残存直腸を切除することが可能であった．腹腔操作を伴わない本術式は術後の早期回復にも寄与し，有用な選択肢の1つであると考えられた．

　We report a case of proctectomy by transanal endoscopic approach without transabdominal assistance to residual proctitis after total colectomy for ulcerative colitis. The patient was a 52-year-old female, who had undergone total colectomy with end-ileostomy at the age of 37. As the residual rectal inflammation persisted and did not improve with drug therapy, we performed completion of proctectomy. Because the pelvis was occupied by the uterus, the residual rectum was safely dissected and extracted only by transanal endoscopic approach without injuring the intraperitoneal organs. This procedure contributed to early recovery after surgery and is considered to be one of the useful options for residual proctitis.