腟式子宮全摘後の腹膜垂の癒着による絞扼性腸閉塞を腹腔鏡下手術で解除した1例

Small bowel obstruction due to adhesion of appendix epiploica after vaginal hysterectomy treated with laparoscopic surgery

◆要旨：症例は54歳女性，前日から続く下腹部痛を主訴に当院へ搬送された．開腹歴はないが，子宮筋腫に対して腟式子宮全摘の既往があった．腸閉塞が疑われたため緊急で腹腔鏡下手術を施行したところ，S状結腸腹膜垂と腟断端が癒着し形成された索状物による絞扼性腸閉塞と診断された．癒着剝離を行い，術後3日に軽快退院となった．開腹歴がなく腟式子宮全摘術が原因となった絞扼性腸閉塞は非常に稀であり，若干の文献的考察を加えてこれを報告する．

　A 54-year-old woman who had undergone vaginal hysterectomy for myoma uteri 11 years ago presented at a local hospital with lower abdominal pain. She was referred to our hospital because bowel obstruction was suspected considering her symptom and image findings though she did not have any history of laparotomy. Laparoscopic surgery was performed and strangulation of the small intestine due to adhesion between sigmoid appendix epipoloica and the vaginal stump was detected. Bowel obstruction was safely treated without bowel resection. The patient had an uneventful postoperative course and left the hospital 3 days after surgery. Strangulated bowel obstruction after vaginal hysterectomy without laparotomy is extremely rare, and only 2 cases have been reported so far. We herein report this rare case along with the relevant literature.