腹腔鏡下S状結腸切除術で根治したS状結腸子宮瘻の1例

A case of uterine-sigmoid colon fistula cured by laparoscopic sigmoidectomy

◆要旨：症例は74歳，女性．2年間持続する便性帯下を主訴に当院を受診した．確定診断に至らなかったが，臨床症状からS状結腸憩室による結腸子宮瘻を強く疑い手術を施行した．S状結腸と子宮の間に瘻孔を認め，それを切離したのちに経腟的に色素を注入し瘻孔の位置，大きさを確認した．瘻孔は細く，瘻孔閉鎖や子宮摘出は不要であると判断し，S状結腸切除のみを施行し手術を終了した．術後1年6か月が経過し，再発はない．結腸子宮瘻は高齢女性に多く，必要最小限の手術手技で治療されることが望ましい．今回，S状結腸子宮瘻に対し腹腔鏡下S状結腸切除のみを施行し，根治に至った症例を経験したので文献的考察を加えて報告する．

　A 74-year-old woman presented with a chief complaint of fecal vaginal discharge persisting for 2 years. Although we did not arrive at a definitive diagnosis, we strongly suspected colouterine fistula due to sigmoid diverticulum from the symptoms and performed the operation. We began the surgery in a manner similar to a usual laparoscopic sigmoidectomy, and adhesions between the bladder, the left side of the uterus, and the sigmoid colon were detached. A fistula was found between the sigmoid colon and uterus, and was dissected. Colored water was then injected through the vagina to confirm the location and size of the fistula. We concluded that the fistula of the uterus was thin, with closure being unnecessary, and performed sigmoidectomy. There has been no recurrence 18 months after the surgery. Colonic diverticular fistula is common in older women, and is better treated with minimal surgical procedures. We report a case of uterine-sigmoid colon fistula treated by laparoscopic sigmoidectomy.