S状結腸卵巣瘻と直腸子宮内膜症を腹腔鏡下に一期的切除しえた1例

A case of successful simultaneous laparoscopic resection of a sigmoid-ovarian fistula and rectal endometriosis

◆要旨：患者は41歳女性で，腹部膨隆を主訴に来院した．腹部CTにて内部にniveauを伴う10cm大に腫大した右卵巣を，大腸内視鏡検査では直腸の狭窄を認め，右卵巣-S状結腸瘻および直腸子宮内膜症と診断した．手術所見では右卵巣とS状結腸が穿通しており，直腸Rs部に狭窄を認めたため，腹腔鏡下低位前方切除術，右付属器摘出術を施行した．経過良好であり，術後10日目に退院となった．病理組織検査にて，右子宮内膜症性卵巣囊胞の感染によるS状結腸穿通，および腸管子宮内膜症による直腸狭窄を疑った．卵巣結腸穿通と腸管子宮内膜症を腹腔鏡下に同時切除可能であった稀な症例を経験したので文献的考察を加え報告する．

　A 41-year-old female presented to our hospital with a chief complaint of abdominal distension. Abdominal computed tomography（CT） revealed a swelling of the right ovary measuring 10 cm in diameter with niveau, and colonoscopy revealed rectal stenosis; based on the finding, the patient was diagnosed as having a right ovarian-sigmoid fistula and rectal endometriosis. Intraoperatively, penetration of the right ovary and sigmoid colon and rectosigmoid stenosis were noted, and laparoscopic lower anterior resection and right oophorectomy were performed. The patient had an uneventful postoperative course and was discharged on day 10 after the surgery. Histopathological examination of the resected specimen led to the diagnosis of an infected chocolate cyst of the right ovary penetrating into the sigmoid colon and rectal stenosis caused by intestinal endometriosis. Here, we report a rare case of successful simultaneous laparoscopic resection of an ovarian-colon fistula and intestinal endometriosis, with a review of the literature.