回腸・直腸に同時発症した腸管子宮内膜症に対して腹腔鏡下手術を施行した1例

Ileal and rectal endometriosis treated by laparoscopic surgery

◆要旨：患者は42歳，女性．腹満を主訴に当院消化器内科を受診した．CTで小腸イレウスの所見を認めたため，イレウス管を挿入し入院となった．症状は改善したが，イレウス管造影で回腸末端に狭窄を認め，大腸内視鏡検査では直腸にも通過障害を認めた．病歴や画像検査から腸管子宮内膜症を疑い，腹腔鏡下に回盲部切除・低位前方直腸切除・左卵巣切除を施行した．術中所見では左卵巣周囲に高度の炎症を認め，近傍に腫瘤状の直腸狭窄部が存在した．回腸末端も同様の所見であった．病理組織学的所見からいずれも子宮内膜症と診断し，術後ホルモン療法にて良好に経過している．腸管子宮内膜症による離れた2か所での腸閉塞は稀であり，また腹腔鏡下に同時手術を行うことで良好な経過を得たので，文献的考察を加えて報告する．

　The patient was a 42-year-old female who was found having ileus which was diagnosed by an abdominal CT scan. The symptom improved by ileus tube. However, small bowel series showed stenosis of the terminal ileum and colon fiber revealed obstruction of the rectum. We predicted endometriosis of the ileum and rectum from the patient's history and physical examination. Resection of the left ovary, ileocecal resection, and low anterior resection of the rectum were performed by laparoscopic surgery. Intraoperative findings showed severe inflammation around the left ovary with stenosis of the nearby rectum. Pathologically, ileal and rectal endometriosis was diagnosed. Hormone was given as adjuvant therapy. We report a patient with ileal and rectal endometriosis causing ileus, treated successfully by laparoscopic surgery, with literature review.