腹腔鏡下大腸全摘術，回腸囊肛門吻合術後に発症した上腸間膜動脈症候群の1例

Superior mesenteric artery syndrome following laparoscopic total proctocolectomy and ileal pouch-anal anastomosis : A case report

◆要旨：腹腔鏡下大腸全摘術後に上腸間膜動脈（以下，SMA）症候群を発症し，保存的治療により改善した1例を経験した．症例は24歳，男性で，high-grade dysplasiaを合併した潰瘍性大腸炎に対して，腹腔鏡下大腸全摘術，回腸囊肛門吻合術を施行した．術後20日目に退院したが，退院翌日に腹痛，嘔吐を主訴に救急搬送された．臨床症状およびCT，消化管造影検査でSMA症候群と診断し，double elementary diet tubeによる減圧，経静脈・経腸栄養や内服加療などの保存的治療で軽快し，再入院後48日目に退院となった．SMA症候群は大腸全摘術後の合併症として稀ではあるが，常に念頭に置く必要がある．

　Superior mesenteric artery（SMA）syndrome is a duodenal obstruction resulting in extrinsic compression of the third portion of the duodenum which is narrowed between the SMA and the abdominal aorta or spine. We herein report a case of SMA syndrome after laparoscopic total proctocolectomy and ileal pouch-anal anastomosis, which was improved by conservative treatment. A 24-year-old man was diagnosed with high-grade dysplasia in ulcerative colitis. He underwent laparoscopic total proctocolectomy and ileal pouch-anal anastomosis. The postoperative course was uneventful, and he was discharged 20 days after surgery. However, he revisited our hospital with complaints of abdominal pain and vomiting the next day after his discharge. He was diagnosed with SMA syndrome based on the symptoms, an upper gastrointestinal series, and an abdominal enhanced CT scan. Conservative treatments were administered using double elementary diet tube with enteral nutrition, and hyperalimentation by central vein high calorie infusion. He was discharged 48 days after readmission without any surgical treatment. Although SMA syndrome after laparoscopic total proctocolectomy is very rare, surgeons should have this syndrome in mind as a cause of postoperative bowel obstruction.