Transanal Endoscopic Microsurgeryにて穿孔部閉鎖を行った医原性直腸穿孔の1例

A Case of Primary Suture Closure Using of Iatrogenic Rectal Perforation Transanal Endoscopic Microsurgery

　症例は77歳，男性．慢性腎不全で加療中であった．大腸ポリープの精査および治療目的で大腸内視鏡検査を施行され，直腸壁の穿孔を生じたため当科を受診した．初診時に臨床症状はなく，血液検査でも炎症所見は認めなかった．大腸内視鏡では肛門縁より約8cmの直腸後壁に穿孔部を認めた．腹部X線，腹部CTでは腹腔内遊離ガス像はなく，骨盤部CTで直腸周囲にガス像を認めた．発症より約3時間で手術を施行した．手術はTEMの手技を用い，穿孔部を吸収糸で連続縫合閉鎖した．手術時間は41分であった．術後経過は良好で，7日目に食事を開始，12日目に退院となった．術後大腸内視鏡では縫合部は瘢痕化し，狭窄も認めなかった．

The patient (77-years old,male) had been followed up for chronic renal failure in our Outpatient Department. He was admitted to our department due to rectal perforation that was found during colorectal endoscopy for precise examination of colonic polyps after barium enema. There were no clinical symptoms nor signs, and no imflammatory findings were detected by laboratory examination.Endoscopic observation revealed perforation in the posterior wall of rectum at about 8 cm above the anal verge.