腹腔鏡補助下に切除術を施行した特発性巨大結腸症に起因したS状結腸軸捻転の1例

A case of sigmoid volvulus associated with idiopathic megacolon treated by laparoscopic-assisted surgery

◆要旨：腹腔鏡補助下に根治術を行ったS状結腸軸捻転の1例を経験した．患者は50歳代，男性．2006年7月にS状結腸軸捻転を初発し，内視鏡下に整復された．同10月，12月にも同症状を繰り返し，整復・症状軽快後の注腸検査にても結腸の拡張，捻れは残存していたため，2007年1月に腹腔鏡補助下S状結腸切除術を施行した．S状結腸から直腸までは著明に拡張しており，拡張腸管切除，機能的端々吻合を行った．特発性巨大結腸症に起因したS状結腸軸捻転と考えられた．S状結腸軸捻転の手術では，腸管拡張による腹腔鏡下手術の難渋が予想されるが，再発の高率な疾患でもあり，再手術の際の癒着の軽減などを鑑みても，腹腔鏡下手術の利点は大きいと考えられる．

　We reported a case of sigmoid volvulus associated with idiopathic megacolon. A 50-year-old man was admitted to our hospital with abdominal pain and distension in July 2006, and he had undergone successful endoscopic decompression with a diagnosis of sigmoid volvulus. In October and December, he had same history of endoscopic decompression for sigmoid volvulus.

　Laparoscopic assisted Sigmoidectomy was performed in January 2007, which revealed a distended and enlarged sigmoid colon and rectum. Resection of distended intestine and functional end-to-end anastomosis was performed. Histologically, no aganglionic change was observed in the resected specimen, and a diagnosis of sigmoid volvulus associated with idiopathic megacolon was made.

　In case of intestinal distension, laparoscopic procedure is thought be difficult because of the poor viewing field of laparoscopy. But sigmoid volvulus has high rate of reccurence and operation is often repeated, so in these cases laparoscopic surgery has advantage with its characteristic of less adhesion.