腹腔鏡補助下結腸亜全摘術を施行した慢性特発性大腸偽性腸閉塞症の1例

Laparoscopy-assisted subtotal colectomy of chronic idiopathic colonic pseudo-obstruction : a case report

◆要旨：患者は43歳，女性．12年間続く便秘を主訴に近医を受診した．注腸検査で上行結腸から下行結腸の口側1/3に著明な拡張を認め，当院に紹介された．画像検査において，小腸に拡張を認めず，直腸粘膜生検で異常を認めなかった．以上から慢性特発性大腸偽性腸閉塞症と診断した．内科的な治療では改善を認めず，腹腔鏡補助下で拡張腸管を切除した．術後経過は良好で，合併症なく退院した．現在，外来で排便の管理を行っており，下剤や浣腸の量が減少し，良好な経過をたどっている．慢性特発性大腸偽性腸閉塞症には外科的な治療の適応があり，腹腔鏡下手術はよい選択肢になると考えられた．

The patient is a 43 year-old woman. For 12 years, she consulted a nearby doctor for severe constipation. Barium enema revealed significant colonic expansion between her ascending colon and one third oral side of the descending colon. Her rectal mucosal biopsy diagnosed negative findings of aganglionosis. As a result, she was diagnosed as chronic idiopathic colonic pseudo-obstruction（CICP）. Considering its resistance to drug therapy, we performed a laparoscopy-assisted resection of the expanded colon. The postoperative course was uneventful and the patient was discharged without any complications. Currently, we are managing her bowel movement in outpatient. She has improved and requires fewer laxatives and enemas. In general, CICP is thought to be a good candidate for operation. We emphasize laparoscopy-assisted resection is a feasible alternative.