突発性慢性便秘症の1手術例 [in Japanese] A Case of Total Abdominal Colectomy for Idiopathic Chronic Constipation [in Japanese]
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症例は22歳,女性.16歳時より便秘が出現し加齢とともに増悪.来院時はあらゆる内科的治療に抵抗性を示し,生活を制約されていた.結腸直腸に形態的異常を認めず,直腸肛門内圧測定検査,defecographyにて二次的な直腸の機能障害を認めたが,排便機能は保たれていた.transit time studyにて著明なslow transit constipationを呈し,大腸亜全摘出(結腸全切除+回腸直腸吻合術)を施行した.術後,良好な排便状態が得られ直腸機能も改善した.切除腸管の鍍銀染色による検討にて,全結腸のAuerbach神経叢内好銀性細胞の減少を認め,結腸の神経原性異常が示唆された,本症の成因,診断,治療について文献的考察を加えて報告する,
This paper reports a case of idiopathic chronic constipation that underwent total abdominal colectomy with laparoscope. A 22-year-old female had severe constipation that was not effected by conservative treatment. There was no morphologic change in the colon and rectum. The function for rectal evacuation was adequate, although rectal compliance decreased and defecography showed secondary rectal function abnormality. The transit time study revealed an obviously slow transit pattern, hence total abdominal colectomy with ileorectal anastomosis was carried out. Postoperative bowel frequency was three or four stools per day, and then rectal function improved. Silver staining of the myenteric plexus showed reduced numbers of argyrophilic neurons significantly in comparison with 10 nonobstructive controls who undewent surgery for colon cancer. The fact that morphologically abnormal argyrophilic neurons of the total colon existed supported the necessity of total colectomy for slow transit constipation.
- Nippon Daicho Komonbyo Gakkai Zasshi
Nippon Daicho Komonbyo Gakkai Zasshi 50(3), 183-190, 1997-03-01
The Japan Society of Coloproctology