脾膿瘍および門脈ガスを伴った脾彎曲部下行結腸癌に対して腹腔鏡下脾合併結腸部分切除術を施行した1例

Laparoscopic partial colectomy with combined resection of spleen for descending colon cancer of splenic flexure with splenic abscess and portal venous gas

◆要旨：症例は81歳，女性．発熱，体動困難で救急搬送された．意識清明，腹部は平坦軟で左側腹部に軽度圧痛を認めた．腹部単純CTで門脈ガス，脾内ガス，脾彎曲部下行結腸壁肥厚を認めた．抗菌薬開始，大腸内視鏡で下行結腸に2型腫瘍を認め，生検で高分化型管状腺癌，脾浸潤または脾穿破を伴った下行結腸癌cT4bN2aM0 StageⅢcの診断で腹腔鏡下脾合併結腸部分切除術を施行した．膵尾部を授動，自動縫合器にて脾門部を一括処理後，左半結腸を授動して強固に癒着した結腸・脾・腹壁を一塊に切除した．病理所見では脾に癌浸潤を認めず，pT3N0M0 StageⅡAであった．術後経過良好で術後16日目に自宅退院となった．

　An 81-year-old woman was transported to our hospital by ambulance complaining of fever and difficulty in moving. The abdomen was soft and flat, with tenderness in the left flank. Plain abdominal CT revealed portal venous gas, splenic gas, and wall thickening of the splenic flexure of descending colon. Antibiotics were started. Colonoscopy revealed type 2 tumor at descending colon, of which biopsy showed well differentiated adenocarcinoma. She underwent laparoscopic partial colectomy with combined resection of spleen for descending colon cancer with invasion perforating to the spleen（cT4bN2aM0 StageⅢc）. During surgery, the pancreatic tail was dissected free from the retroperitoneum, splenic hilum was cut using stapling device, left hemi-colon was dissected free from retroperitoneum, and then, en bloc resection of colon cancer adherent to spleen and abdominal wall was performed. Pathological diagnosis was pT3N0M0 StageⅡA without invasion to spleen. Postoperative course was good and she was discharged on postoperative day 16.