腹腔鏡下S状結腸切除術後,腸間膜欠損部への内ヘルニアによる絞扼性腸閉塞の1例  [in Japanese] Strangulated Bowel Obstruction due to a Mesenteric Defect Internal Hernia after Laparoscopic Sigmoid Colon Resection  [in Japanese]

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<p>症例は43歳女性.S状結腸癌,転移性肝腫瘍,左卵巣腫瘍に対し腹腔鏡下S状結腸切除・肝部分切除・左付属器切除術が施行された.術後4ヵ月目に発症した絞扼性腸閉塞に対して緊急手術が施行された.原因はS状結腸の腸間膜欠損部と初回手術時に温存された上直腸動脈間が門となる内ヘルニアであった.小腸部分切除,腸間膜欠損部の縫合閉鎖を行った.腹腔鏡下大腸切除手術後,腸間膜欠損部が原因の内ヘルニアの発生率は少なく,腸間膜欠損部は閉鎖しないことが一般的である.本症例は,S状結腸が過長で,腸間膜と後腹膜の癒合が少ないという特徴があった.このような症例では術後の癒着による腸間膜欠損部の閉鎖がされず,内ヘルニアのリスクが高いと考えられ,閉鎖すべきと考えられた.</p>

<p>A 43-year-old woman underwent laparoscopic sigmoidectomy, partial hepatectomy and left oophorectomy for sigmoid colon cancer with liver metastasis and right ovarian tumor. Four months after the operation, she was admitted with strangulated bowel obstruction and an emergency laparotomy was performed. Necrotic small intestine was found incarcerated through the mesenteric defect from the previous colon resection. Partial resection of the necrotic small intestine and closure of the mesenteric defect were performed. The postoperative course was uneventful. This patient had a long sigmoid colon, which may have resulted in insufficient adhesion of the mesenteric defect to the retroperitoneum, leading to this internal hernia. Care must be taken to close the mesenteric defect after laparoscopic colonic resection.</p>

Journal

  • Nippon Daicho Komonbyo Gakkai Zasshi

    Nippon Daicho Komonbyo Gakkai Zasshi 72(4), 165-170, 2019

    The Japan Society of Coloproctology

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