経肛門的および腹腔鏡操作の併用で整復し切除しえた成人直腸重積症の1例

A case of adult rectal intussusception caused by sigmoid colon cancer resected after reduction by combined transanal and laparoscopic approach

◆要旨：患者は60代の女性．便秘・下血を主訴に近医を受診し，腹部CTで直腸重積が疑われ当科紹介となった．精査の結果S状結腸癌による直腸重積の診断となり，非観血的整復を試みたが困難で手術を施行した．術中に経肛門的および腹腔鏡操作の併用で整復を行った．重積部は高度腸管浮腫を認めたため腹腔鏡下Hartmann手術を行った．術後経過良好で退院後約3か月でストーマ閉鎖術を行った．S状結腸癌の直腸重積の整復に経肛門的および腹腔鏡操作の併用が有用であった．また整復することで腹腔鏡による根治術や，肛門機能の温存が可能であった．

A woman in her sixties visited a local clinic with a chief complaint of constipation and bloody stool. She was referred to our department with suspected rectal intussusception based on the findings of an abdominal computed tomography （CT） scan. Detailed examination confirmed the diagnosis of rectal intussusception caused by sigmoid colon cancer. Although closed reduction was attempted, due to its difficulty, surgical operation was performed. A combined transanal and laparoscopic approach was used as the intraoperative reduction procedure. Laparoscopic Hartmann's procedure was performed as severe intestinal edema at the site of intussusception was observed. The patient was discharged with a good postoperative course and approximately 3 months after discharge colostomy closure was performed. A combined transanal and laparoscopic approach was effective in reducting the rectal intussusception caused by sigmoid colon cancer. Reduction enabled a laparoscopic radical operation and preservation of anal function.