腹腔鏡下直腸固定術後に有棘縫合糸の癒着による絞扼性腸閉塞を発症した1例

A case of strangulated intestinal obstruction due to adhesion of barbed suture after laparoscopic rectopexy

◆要旨：症例は87歳，女性．直腸脱に対して腹腔鏡下直腸固定術を施行した．術中の腹膜閉鎖で有棘縫合糸を使用した．術後9日目に腹痛，嘔吐を認め，腹部造影CTでclosed loopを呈す絞扼性腸閉塞と診断し再手術とした．腹腔内では初回手術時の有棘縫合糸断端が小腸間膜と癒着しbandを形成していた．これを切離し，絞扼を解除した．以後，症状の再燃はなく退院した．簡便な縫合を可能にする有棘縫合糸は有用だが，腹腔内手術においては，その癒着が腸閉塞の原因となる可能性があり，余剰断端長の調節，気腹解除後の糸の緩みを予防する逆方向への運針など，縫合糸を可能な限り露出させない対策を行う必要がある．

　The patient was an 87-year-old woman. Laparoscopic rectopexy was performed for rectal prolapse. Barbed suture was used to perform peritoneal closure in the abdominal cavity. On the 9th postoperative day, she experienced abdominal pain and vomiting and was diagnosed as having a strangulated intestinal obstruction with closed loop as shown by abdominal contrast-enhanced computed tomography, and reoperation was performed. Observation of the abdominal cavity revealed that the stump of the barbed suture used in the first operation had adhered to adjacent small intestinal mesentery to form a band. The extra part of the suture was removed, and the strangulation was released. After the reoperation, she discharged without relapse of symptoms.

　Although barbed suture, which enables simple suturing, is useful, it can cause adhesions leading to bowel obstruction in intra-abdominal surgery. It is thus necessary to take sufficient measures to prevent the suture from being exposed as much as possible, such as by appropriate adjustment of the excess stump length and placing a well-designed final stitch to prevent loosening after release of pneumoperitoneum.