瘻孔を形成した直腸子宮内膜症の1例  [in Japanese] ENDOMETRIOSIS OF THE RECTUM FORMING A FISTULA  [in Japanese]

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子宮内膜症性卵巣嚢腫と瘻孔を形成した直腸子宮内膜症の1例を経験したので報告する.症例は34歳の女性で,主訴は下血と下腹部痛である.大腸内視鏡検査で直腸に粘膜下腫瘍様病変を認め,注腸造影で直腸から腸管外への造影剤の流出と貯留がみられた. CT検査, MRIにて嚢胞状腫瘤を認め,子宮内膜症性卵巣嚢腫の直腸への瘻孔形成と診断した.下血が持続するため嚢腫,瘻孔部,子宮付属器を含めた直腸切除術を施行した.摘出標本では直腸の筋層に子宮内膜腺の浸潤がみられた.術後4年経過したが再発の徴候はみられていない.瘻孔を形成した腸管子宮内膜症に対しては積極的な外科的治療が必要であると考えた.

We experienced a case of endometriosis of the rectum forming an ovarial cyst with endometriosis and fistula.<br> A 34-year-old woman was admitted to the hospital because of anal bleeding and lower abominal pain. Colonoscopic examination revealed a submucosal tumorous lesion in the rectum. Barium enema showed a leakage and retention of contrast medium from the rectum. CT and magnetic resonance imaging visualized a cystic tumor of the rectum. A diagnosis of fistula formation of endometrial ovarian cyst to the rectum was made. Because of persisting anal bleeding, excision of the rectum including the cyst, fistula and adnexa uteri was carried out. The excised specimen revealed an infiltration of the endometrial gland into the muscular layer of the rectum. There has been no sign of recurrence, as of about 4 years after the operation. It is though that agressive surgical treatment is necessary for fistula-forming endometriosis of the intestine.

Journal

  • The journal of the Japanese Practical Surgeon Society

    The journal of the Japanese Practical Surgeon Society 57(3), 653-657, 1996-03-25

    Japan Surgical Association

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