腹腔鏡下大腸亜全摘術を施行した慢性特発性大腸偽性腸閉塞症の1例

Laparoscopic subtotal colectomy for chronic idiopathic colonic pseudo-obstruction : A case report

◆要旨：症例は77歳，女性．4年前より糞便性腸閉塞の診断で計6回入退院を繰り返した．腹部CT検査と注腸造影検査で結腸全体に著明な拡張と蠕動不良を認め,大腸通過時間検査（放射線非透過性マーカー使用）では服用5日目で結腸内に多数の停滞を認めた．以上より慢性特発性大腸偽性腸閉塞症と診断し，排便造影検査で肛門機能が保たれていたため，大腸亜全摘の適応とし腹腔鏡下大腸亜全摘術を施行した．術後は良好に経過し，腸閉塞症状の再燃なく外来通院中である．慢性特発性大腸偽性腸閉塞症は薬物療法が抵抗性の場合には罹患腸管の切除が有効とする報告が多い．本邦の腹腔鏡手術の報告例は5例と少ないが，腹腔鏡手術はよい選択肢になると考えられた．

　A 77-year-old woman was hospitalized on six occasions for constipation and abdominal fullness. Following contrast enema administration, she underwent abdominal computed tomography, which revealed significant colonic dilatation between the ascending and transverse colon. The bowel transit time test revealed reduced colorectal motility, and defecography revealed good anal function. Based on these findings, the patient was diagnosed with chronic idiopathic colonic pseudo-obstruction （CICP） and underwent laparoscopic subtotal colectomy. Her postoperative course was uneventful, and she was discharged without complifcations and did not experience any constipation or abdominal fullness thereafter. In case of drug resistance, CICP is thought to be a good candidate for operation. Laparoscopic surgery can be a feasible alternative.