左腸骨窩腎移植後の反復性S状結腸憩室出血に対してIMV firstアプローチが有効であった腹腔鏡下S状結腸切除術の1例

IMV first approach is effective in laparoscopic sigmoidecomy after left kidney transplantation : A case of diverticulum hemorrhage

◆要旨：症例は66歳，男性．18年前に左腸骨窩腎移植の既往あり．血便を主訴に内科を受診，S状結腸憩室出血の診断となった．内視鏡下に止血を施行したが，再出血を繰り返すため腹腔鏡下S状結腸切除術を施行した．移植腎のある腸骨稜付近は剝離・授動に難渋することが予想され，IMV firstアプローチを行う方針とした．IMVの背側の結腸間膜を切開し授動を開始，直腸後腔からも授動を行い頭側からの剝離層を保ちつつ，挟み撃ちし下行結腸からS状結腸を授動した．移植腎を損傷することなく腹腔鏡下S状結腸切除術を行った．合併症なく術後15日目に退院した．左腎移植後の腹腔鏡下S状結腸切除術においてはIMV firstアプローチが有効と考えられたため報告する．

　A 66-year-old man who had undergone left kidney transplantation 18 years earlier visited our hospital with bloody stool. Diverticulum bleeding in the sigmoid colon was diagnosed and endoscopic hemostasis was performed, but the bleeding recurred. Laparoscopic sigmoidectomy with IMV first approach was performed because it was difficult to mobilize the mesentery around the iliac fossa. The mobilized mesentery was incised on the dorsal side of the IMV. Mobilization was also performed from the posterior space of the rectum while maintaining the detached layer on the cranial side, and from the descending colon to the sigmoid colon. Laparoscopic sigmoidectomy was performed without damaging the transplanted kidney. The patient was discharged 15 days after surgery without complications. This case shows that an IMV first approach can be effective in laparoscopic sigmoidectomy after left kidney transplantation.