重積を整復せずに腹腔鏡下根治切除，消化管吻合が可能であったS状結腸癌肛門外脱出の1例

A case of extra-anal prolapse of sigmoid colon carcinoma resected radically and anastomosed without reduction by laparoscopic surgery

◆要旨：症例は80代，女性．肛門からの腸管脱出にて近医より紹介があり救急搬送された．診察上，肛門より重積した腸管の脱出があり，先進部には1型腫瘍を認めた．CT検査では，脱出腸管はS状結腸で直腸内で反転し重積していた．脱出腸管は暗赤色を呈しており，重積の整復は穿孔の危険もあり緊急手術の方針とした．腹腔鏡下に手術を行い，術中も重積は整復せず直腸の授動を肛門挙筋付着部まで行い，術中直腸診を行い重積腸管の肛門側で直腸を切離し超低位前方切除，D3郭清を行った．検体では重積先進部に1型腫瘍を認め，周囲粘膜は虚血性変化を認めたが壊死や穿孔はなかった．

　An 80-year old woman was referred to our hospital for an intestinal prolapse through the anus. On inspection, a prolapse of the invaginated intestine with an associated type 1 tumor in the advanced part of the prolapse was observed. A CT scan showed a prolapsed and reversed sigmoid colon in the rectum. The mucosa of the prolapsed sigmoid colon was dark-red in color. We performed an emergency laparoscopic surgery to repair the invaginated sigmoid colon due to the risk of perforation. The mesorectum was mobilized up to the attachment of the levator muscle of the anus. By intraoperative digital examination, the rectum was resected at the anal side of the invaginated intestine. Additionally, we performed an ultra-low anterior resection and D3 dissection of lymph nodes. The specimen revealed a type 1 tumor in the advanced part of the invagination, and the surrounding mucosa showed ischemic changes. However, no signs of necrosis or perforation were identified.

　The attached paper titled“A case of extra-anal prolapse of sigmoid colon carcinoma resected radically and anastomosed without reduction by laparoscopic surgery.”has been carefully reviewed by an experienced medical editor whose first language is English and who specializes in the editing of papers written by physicians and scientists whose native language is not English.