性転換手術後に発生した直腸膣瘻の1例  [in Japanese] Rectovaginal Fistula Developed after Sex Reassignment Surgery : A Case Report  [in Japanese]

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Abstract

22歳,男性.主訴は入工膣からのガス・便の排出.1年10か月前に海外で膣造設術を含む性転換手術を受けている.造影および内視鏡検査では瘻孔は高位にあり,直腸膣中隔の膣側上皮は広汎に欠損していた.手術は経仙骨的アプローチで施行し,直視下に瘻孔を切除して層々に縫合閉鎖した.術後3年以上経過した現在,再発はない,本症例は腹部や大腿部に創痕が残るような術式を拒んだため,瘻孔を閉鎖できたが,膣を安全に使用できるような術式ではなかった.男性性転換手術者に発生する直腸膣瘻の治療は困難で,その理由として発生原因が人工膣の萎縮防止用ステントを長期間使用したための圧迫壊死であること,および造膣手術時に広範囲に剥離が行われていて周囲組織を瘻孔閉鎖手術時の修復に利用できないことなどがあげられている.欧米の報告では本症の発生率は低いが,観察期間が短いものが多いことから過小評価されている可能性が考えられる.

A 22-year-old male-to-female transsexual was admitted to our clinic with a complaint of gas and fecal discharge from the neo-vagina. Sex reassignment surgery, including construction of the neo-vagina, had been performed 22 months previously. Contrast radiography and endoscopy revealed a high fistula located near the vault and partial loss of the epithelial lining of the vagina.<BR>Transsacral route excision of the fistula was performed with layer closure plus interposition of the mesorectum. The patient has been recurrence-free for more than 3 years since the repair. Vaginal function was not restored in the present case because he refused to allow his body to be injured. Repair of rectovaginal fistula as a complication of sex reassignment surgery seems difficult due to the obturator decubitus caused by protracted use of a stent to prevent vaginal shrinkage and wide dissection of the perineum. The incidence of this complication may be underestimated because of shortness of the observation period.

Journal

  • Nippon Daicho Komonbyo Gakkai Zasshi

    Nippon Daicho Komonbyo Gakkai Zasshi 51(1), 18-23, 1998-01

    The Japan Society of Coloproctology

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