骨盤内動静脈奇形合併の直腸癌に対して腹腔鏡下に根治的切除を行った1例

A case of curative laparoscopic resection of rectal cancer complicated by pelvic arteriovenous malformations

◆要旨：患者は58歳，男性．腹部膨満感と便通異常を主訴に2015年12月に近医を受診し，直腸癌の診断にて当科を紹介され受診した．下部消化管内視鏡検査にて直腸S状部に亜全周性3型病変を認めた．生検では高分化腺癌と診断された．腹部CT検査では直腸に壁肥厚を認め，有意なリンパ節腫大を認めた．また骨盤内に動静脈奇形（AVM）が確認された．直腸癌（cT3, cN1, cM0, cStageⅢa）に対して，2016年1月に腹腔鏡下高位前方切除術（D3郭清）を安全に施行しえた．骨盤内にAVMが発生する頻度は約3％とかなり稀である．今回，骨盤内AVM合併の直腸癌を経験したので若干の文献的考察を含めて報告する．

　The subject, a 58-year-old man, visited his local doctor in December 2015 with a chief complaint of abdominal distension and irregularities in bowel movements. The local doctor made a diagnosis of rectal cancer and referred him to our department. A lower gastrointestinal endoscopy detected a type 3 semi-circumferential lesion in the rectosigmoid colon and biopsy demonstrated a well-differentiated adenocarcinoma. An abdominal CT scan showed wall thickening and significant lymphadenopathy in the rectum. In addition, arteriovenous malformations（AVM） were identified in the pelvis. For the rectal cancer（cT3, cN1, cM0, cStage Ⅲa）, a high anterior laparoscopic resection（D3 dissection） was successfully performed in January 2016. The reported incidence of AVMs in the pelvis is approximately 3％. Herein, we report our case of rectal cancer complicated by pelvic AVMs and present a review of the existing literature.