結腸吻合部狭窄に対するバルーン拡張時の穿孔を腹腔鏡および内視鏡補助下に自動吻合器で閉鎖した1例

A case of repairing a colon perforation which occurred after balloon dilatation for post-operative stricture, using a circular stapler with laparoscopic and colonoscopic assistance

◆要旨：患者は68歳，男性．多発大腸憩室症にてS状結腸憩室炎，憩室出血を繰り返したため腹腔鏡下高位前方切除術を行った．術後に吻合部狭窄を原因とした吻合部潰瘍による出血をきたしたため，バルーン拡張術を行ったところ再狭窄をきたし拡張術を繰り返した．3回目のバルーン拡張術の際に穿孔をきたしたため緊急手術を行った．腹腔鏡，下部消化管内視鏡補助下にサーキュラーステイプラーを経肛門的に用いて穿孔部の切除を行った．低侵襲で穿孔部の閉鎖と狭窄の拡張を同時に達成し，術後経過も良好であった．筆者らが行った術式について報告する．

A 68-year-old man had undertaken laparoscopy assisted high anterior resection for diverticulitis and repeated bleeding from diverticulosis of sigmoid colon. He had bleeding from an ulcer occurring from post-operative anastomotic stricture. We tried endoscopic balloon dilatation, but repeated endoscopic dilatation was required due to re-stricture. At the third dilatation, perforation had occurred, and emergency operation was required. We used a circular stapler transanally, and resected the perforation site with laparoscopic and colonoscopic assistance. We succeeded in the closure of the perforation site and the dilatation of stricture by a less invasive procedure. No post operative complication and re-stricture were noted. Here we report our procedure.