慢性特発性大腸偽性腸閉塞に対して腹腔鏡下大腸亜全摘術を施行した1例

Laparoscopic subtotal colectomy of chronic idiopathic colonic pseudo-obstruction：a case report

◆要旨：慢性特発性大腸偽性腸閉塞症に対して，前処置の工夫で腹腔鏡下大腸亜全摘術を安全に施行しえた1例を経験した．症例は68歳，女性．S状結腸軸捻転で腹腔鏡下S状結腸切除術を施行された．3年後に腹部膨満と食欲低下で再診し，画像検査で結腸全体の著明な拡張を認め，慢性特発性偽性腸閉塞と診断した．外科的手術の方針で，術前日に経肛門的イレウス管を留置した．減圧は良好であり，腹腔鏡下に大腸亜全摘を施行した．術後腸閉塞を認めたが，術後16日目に軽快退院した．術前の経肛門的イレウス管による減圧は，慢性特発性大腸偽性腸閉塞症に対して腹腔鏡下大腸亜全摘術を安全に施行しうるために有用であった．

　A 68-year-old woman underwent laparoscopic sigmoid colectomy for sigmoid colonic volvulus, 3 years prior to presentation. Histopathological examination of the resected sigmoid colon showed negative findings for aganglionosis. She was admitted to our hospital with abdominal distention and loss of appetite in December 2020. Colonic computed tomography revealed significant colonic distention between the transverse and left-sided colon, and she was diagnosed with recurrent chronic idiopathic colonic pseudo-obstruction（CICP）. She was considered as a surgical candidate, thus, we performed laparoscopic subtotal colectomy with preoperative placement of a transanal decompression tube. The operation time was 184 min, and the intraoperative blood loss was 5mL. The patient developed postoperative paralytic ileus; however, she was discharged on the 16th postoperative day. She did not experience any severe symptoms postoperatively and was prescribed medications which she continued for 5 months after the surgery, to promote intestinal movement. Resection of the distended colon is usually performed for CICP; however, it is challenging to secure an optimal view of surgical field during laparoscopic colectomy due to colonic distention. We emphasize that laparoscopic subtotal colectomy with decompression using a transanal tube is feasible for CICP.