経肛門的小腸脱出をきたした特発性直腸穿孔に対して腹腔鏡下手術を施行した1例

Laparoscopic surgery for idiopathic rectal rupture associated with small bowel prolapse through the anus : A case report

◆要旨：経肛門的小腸脱出を伴う特発性直腸穿孔はきわめて稀な病態である．患者は70歳，女性．排便時に肛門からの小腸脱出を認めて近医を受診し，腹部CTにて直腸内への小腸の陥入を認め，加療目的に当院搬送となり同日緊急手術を施行した．まず腹腔鏡にて腹腔内を観察したところ，直腸前壁を通じて小腸が直腸内に陥入していた．小腸は色調不良をきたしており血流障害が疑われたが，腹腔内汚染や腹水は認めなかった．腹腔鏡下に陥入を解除し，穿孔部位を含む直腸を切除，吻合し，小腸部分切除と予防的回腸人工肛門造設を行った．術後経過は良好であり，第12病日に退院となった．

　Perforation of rectum with prolapse of small bowel through anus is a very rare case. There has been no report of this condition that was treated by laparoscopic surgery. The patient was a 70 years old female who had a sudden anal pain. She noticed intestinal prolapse through her anus when she had a bowel movement and the prolapsed intestine was put back by a local physician. Abdominal CT scan revealed an invagination of small bowel into the rectum that had prolapsed, and she was referred to our hospital for treatment. An emergency operation was performed and laparoscopic surgery was chosen by patient's request. The small bowel was found to have entered the rectum through its perforated anterior wall. When the small bowel was pulled back, it seemed to be congested. Because there were almost no contamination or ascites in her abdominal cavity, approximately 5cm of the rectum and 35cm of the small intestine were resected, then rectal anastomosis and ileostomy were placed. She was discharged from our hospital on her 12th postoperative day uneventfully.