S状結腸憩室炎穿通による直腸間膜膿瘍に対し超音波内視鏡下経直腸的ドレナージ後に鏡視下手術を施行した1例

A case of laparoscopic surgery after endoscopic ultrasonography-guided transrectal drainage for mesorectum abscess caused by the penetration of sigmoid colon diverticulitis

◆要旨：患者は42歳，男性．下腹部痛，発熱の精査で当科を紹介され受診となる．CTで多発S状結腸憩室と骨盤内の直腸周囲に膿瘍形成を認めた．S状結腸憩室炎穿通に伴う直腸間膜膿瘍と診断し，超音波内視鏡下経直腸的ドレナージを施行し内瘻チューブを留置した．炎症所見の改善，膿瘍腔の縮小を確認し，処置後35日目に根治目的に鏡視下手術の方針とした．直腸S状部の直腸間膜と骨盤内左側腹膜が強固に癒着し，骨盤内腹膜も炎症性に肥厚，硬化し易出血性であったが，腹腔鏡下低位前方切除術を施行しえた．術後合併症なく経過し軽快・退院した．現在，退院後5か月経過しているが，直腸周囲膿瘍の再燃や排便機能障害は認めていない．

　A 42-year-old man was referred to our department because of lower abdominal pain and fever. Computed tomography revealed the sigmoid colon with many diverticula and abscess formation around the rectum in the pelvis. We diagnosed the patient as having a mesorectum abscess due to penetration of sigmoid colon diverticulitis. Endoscopic ultrasonography-guided transrectal drainage was performed and an internal fistula tube was placed. After the improvement of inflammation and the reduction of abscess cavity, laparoscopy-assisted low anterior resection was performed. Operative findings revealed that the rectosigmoid colon adhered severely to the left pelvic peritoneum that was thickened and bled easily. The patient was discharged on the 13th postoperative day. No recurrence of perirectal abscess or defecation dysfunction has been observed, five months after the surgery.