腹腔鏡補助下で経肛門的にワインオープナーを用いて摘出した直腸複数異物の1例

Laparoscopy-assisted transanal retrieval of self-inserted multiple colorectal foreign bodies using a corkscrew : a case report

◆要旨：患者は65歳の男性で，3日前経肛門的にボール2個とレモンを挿入した．抜去が困難となったが放置し，腹部膨満をきたしたため当院に来院した．CTでS状結腸から直腸に最大径7.1cm大の異物を認めた．大腸内視鏡など種々の器具を用いて異物の摘出を試みたが摘出できず，腹腔鏡補助下で異物を摘出する方針とした．全身麻酔下に腹腔内を腹腔鏡で観察しながら，鉗子を用いて直腸内へ異物を誘導した．経肛門的に手を直腸内へ挿入して摘出を試みたが摘出できず，ボールを手で把持しながらワインオープナーを刺入して摘出した．摘出困難な直腸異物に対しては，術前に異物の形状・材質を確認し，腹腔鏡下手技を組み合わせることが有用であると考えられた．

A 65 year-old male who had inserted 2 balls and a lemon into the rectum for erotic stimulation 3 days previously, visited the hospital complaining of abdominal distension and constipation. Abdominal CT confirmed retained foreign bodies, 7.1 cm in maximum diameter, located between the rectum and the sigmoid colon. We failed to extract the foreign bodies by colonoscopy. We, therefore, tried laparoscopically assisted transanal manual retrieval under general anesthesia. Under laparoscopic observation, we pushed the foreign bodies towards the anus using laparoscopic forceps. A corkscrew was plunged into the distal foreign body and was successfully pulled out like a cork from a wine bottle. The same maneuver was repeated for the other foreign bodies. When removing colorectal foreign bodies that are difficult to extract, it is important to consider their shape, material, location as revealed by diagnostic imaging. Furthermore, transanal retrieval of colorectal foreign bodies assisted by laparoscopic observation is an useful method.