腹腔鏡下S 状結腸切除術半年後に発症し緊急手術を要した静脈うっ滞による 虚血性腸炎の1 例

A 75-year old woman with a history of hypertension, hyperlipidemia and surgery for uterine myoma underwent laparoscopic sigmoidectomy and D3 lymph node dissection for sigmoid colon cancer. Constipation, anal discomfort, and clear drainage from the anus began 5 months after the operation, and a month later she visited our hospital. At 6 months after laparoscopic sigmoidectomy, CT revealed a severely thickened rectum from the anastomosis to the anus and dilatation of the internal iliac vein; and colonoscopy revealed severe erosion from the anastomosis to the anal side. Conservative treatment for about one month did not improve her symptoms and findings, and she then developed extensive anal bleeding and hypovolemic shock. Severe edema and fibrosis of the rectum and surrounding tissue were found in an emergency operation, and abdominoperineal resection was performed. Macroscopic findings of the resected specimen showed a severely thickened rectum wall. Histological findings showed dilated and meandering veins with congestion from the rectal submucosa to perirectal tissue.