直腸憩室炎による膀胱瘻に対する腹腔鏡下根治術の1例

A case of rectovesical fistula due to rectal diverticulitis radically treated by laparoscopic rectal resection

◆要旨：患者は67歳，男性．下腹部痛があり保存的に加療されていたが改善がなかった．直腸憩室炎により直腸膀胱瘻を発症し，骨盤内膿瘍および直腸狭窄を伴っていた．人工肛門造設術を施行し，炎症は軽快した．慎重に経過観察を行っていたところ，炎症の再増悪を認め，人工肛門造設術後4年で腹腔鏡下前方切除にて根治術を施行した．直腸憩室による直腸膀胱瘻は非常に稀な疾患である．診断においては悪性疾患である直腸癌との鑑別が必要であり，また良性疾患であるため手術侵襲を最小限にすることが重要となる．今回，直腸憩室炎による直腸膀胱瘻に対し腹腔鏡下に根治術を施行した1例を経験したので報告する．

　A 67-year-old male who had lower abdominal pain was diagnosed as having rectovesical fistula due to rectal diverticulitis with complicated stenosis and intrapelvic abscess formation. Although the temporal colostomy was performed to control the local inflammation, patient's condition due to rectovesical fistula became worse. Four years after the first treatment, radical laparoscopic rectal resection was performed, retaining colostomy. The patient's condition improved dramatically. Pathogenesis of rectovesical fistula due to diverticulitis is complicated. However, since it is basically a benign disease, the minimized operation to maintain rectal functions is preferable. We report this successful case of laparoscopic surgery in a patient with rectovesical fistula due to diverticulitis.