経肛門的小腸脱出をきたした特発性直腸穿孔に対する腹腔鏡下手術の経験

Laparoscopic surgery of small bowel prolapse from perforated rectum : A case report

◆要旨：患者は68歳，女性で，関節リウマチに対してプレドニゾロン2.5mgを内服中であった．10年前から直腸脱を自覚していたが，排便時に肛門から腸管の脱出を認め，当院へ救急搬送となった．肛門から小腸が約30cmにわたって脱出しており，腹部CT検査を施行したところ直腸内に小腸が陥入し，体外へ脱出していた．脱出した腸管を用手還納し，直腸穿孔の診断で腹腔鏡下に緊急手術を行った．直腸Ra前壁に約4cm長の長軸方向の裂傷を認めた．腹腔内の汚染は軽微と判断し，直腸裂傷部を腹腔鏡下に縫合閉鎖し，回腸瘻を造設して手術終了とした．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症例を経験したので報告する．

A 68-year-old woman who had been taking 2.5 mg of prednisolone for rheumatoid arthritis and was aware of rectal prolapse lasting 10 years was transported by ambulance to our hospital because of intestinal prolapse from the anus observed during defecation. Approximately 30 cm of small intestine had prolapsed from the anus, and abdominal CT showed small intestinal invagination into the rectum and prolapse outside the body. The prolapsed intestine was manually induced, and she was diagnosed with rectal perforation, for which emergency laparoscopic surgery was performed. A laceration measuring approximately 4 cm in the longitudinal direction was observed in the anterior wall of the rectum（Ra）. Intraperitoneal contamination was deemed to be minor; the rectal laceration was endoscopically sutured closed, and an ileostomy was formed to complete the surgery. We report our experience with a case of laparoscopic surgery for an idiopathic rectal perforation that had caused transanal prolapse of the small intestine.