経肛門的マイクロサージェリー(TEM)で切除し得た直腸平滑筋腫の1例 A Case of Rectal Leiomyoma Resected by Transanal Endoscopic Microsurgery

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症例は72歳男性,現病歴では2mm年4日5日に腹腔鏡下胆嚢摘出術が施行されていた.その際,入院時の直腸診で下部直腸の前壁側に拇指頭大の硬い腫瘤を触知し,大腸内視鏡検査で下部直腸の前壁側に黄色調で半球状の粘膜下腫瘤を認めた.筋原性の粘膜下腫瘍の診断で経肛門的マイクロサージェリー(tran-sanal endoscopic microsurgery:以下TEM)を行った.摘出標本は22×15mm,黄白色の充実性腫瘍で病理学的には平滑筋腫であった.

Leiomyoma of the rectum is relatively rare and is difficult of histological diagnosis preoperatively. In some cases, a colonoscopic polypectomy is needed for definite diagnosis. With a large tumor, this procedure involves a risk of perforation through gastrointestinal system.<BR>We successfully resected a leiomyoma of the rectum which was difficult of colonoscopic polypectomy by transanal endoscopic microsurgery.<BR>A 72-year-old man had a laparoscopic cholecystectomy in our hospital on April 5, 2000. Digital examination revealed a thumb tip-sized hard mass on the low anterior wall of the rectum. Anoscopy showed a yellowish semilunar submucosal tumor, which was diagnosed as a myogenic submucosal tumor, and subsequently transanal endoscopic microsurgery was performed. The tumor was 25×15mm in size. The cut surface of the solid tumor was yellowish-white. The histological diagnosis was leiomyoma. The postoperative course was uneventful. It was thought that transanal endoscopic microsurgery might contribute to safe and minimally invasive resection for leiomyoma of the rectum.

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  • 日本大腸肛門病学会雑誌

    日本大腸肛門病学会雑誌 55(5), 225-228, 2002-05-01

    The Japan Society of Coloproctology

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