内容紹介
A Case Report of Robotic Assisted Laparoscopic Low Anterior Resection in a Patient with Rectal Cancer and Polysplenia Syndrome
Summary
Polysplenia syndrome is a rare congenital disease characterized by variable thoracic and abdominal anomalies. A man in his 70s was diagnosed with rectal cancer by close exploration for fecal occult blood. A barium enema revealed a type 1 rectal tumor and with non-rotation of intestine. CT revealed multiple abnormalities: a polyspleen, preduodenal portal vein, congenital absence of the pancreatic tail, bilateral superior vena cava, and bilateral bilobed lung. Based on these findings, the patient was diagnosed as having rectal cancer with polysplenia syndrome and treated with robotic assisted laparoscopic low anterior resection. At operation, the whole colon was located in the left side of the abdominal cavity. The whole colon adhered with each other. The ileocecum adhered to the front of the aorta and the right iliac artery. In the pelvis, anatomical abnormality was not detected and rectal mobilization and resection was performed as usual. The patient had no signs of recurrence of the rectal cancer. This is the first case presentation of laparoscopic low anterior resection in a patient with rectal cancer and polysplenia syndrome.
要旨
多脾症候群は多脾を伴い多彩な内臓位置異常を特徴とする先天性疾患である。症例は70歳台,男性。便潜血陽性を指摘され精査の結果,直腸癌と診断された。下部消化管造影検査で上部直腸に1型腫瘍を認め,結腸は左側に偏移しnon-rotation型腸回転異常の所見を呈していた。腹部造影CT検査で多脾,十二指腸前門脈,膵尾部欠損,左上大静脈遺残を認めた。以上より多脾症候群を伴う直腸癌と診断し,ロボット支援下腹腔鏡下低位前方切除術を行った。手術所見は結腸全体が左側に偏位し,結腸どうしの広範な癒着および盲腸から上行結腸の大動脈前面への癒着を認めたため,癒着剥離を行った。下腸間膜動脈の走行および骨盤内に解剖異常を認めず,中枢側リンパ節郭清を伴う直腸切除術が施行可能であった。多脾症候群を伴う直腸癌に対し,腹腔鏡下切除術を行った報告は自験例が1例目であるため報告する。
目次
Summary
Polysplenia syndrome is a rare congenital disease characterized by variable thoracic and abdominal anomalies. A man in his 70s was diagnosed with rectal cancer by close exploration for fecal occult blood. A barium enema revealed a type 1 rectal tumor and with non-rotation of intestine. CT revealed multiple abnormalities: a polyspleen, preduodenal portal vein, congenital absence of the pancreatic tail, bilateral superior vena cava, and bilateral bilobed lung. Based on these findings, the patient was diagnosed as having rectal cancer with polysplenia syndrome and treated with robotic assisted laparoscopic low anterior resection. At operation, the whole colon was located in the left side of the abdominal cavity. The whole colon adhered with each other. The ileocecum adhered to the front of the aorta and the right iliac artery. In the pelvis, anatomical abnormality was not detected and rectal mobilization and resection was performed as usual. The patient had no signs of recurrence of the rectal cancer. This is the first case presentation of laparoscopic low anterior resection in a patient with rectal cancer and polysplenia syndrome.
要旨
多脾症候群は多脾を伴い多彩な内臓位置異常を特徴とする先天性疾患である。症例は70歳台,男性。便潜血陽性を指摘され精査の結果,直腸癌と診断された。下部消化管造影検査で上部直腸に1型腫瘍を認め,結腸は左側に偏移しnon-rotation型腸回転異常の所見を呈していた。腹部造影CT検査で多脾,十二指腸前門脈,膵尾部欠損,左上大静脈遺残を認めた。以上より多脾症候群を伴う直腸癌と診断し,ロボット支援下腹腔鏡下低位前方切除術を行った。手術所見は結腸全体が左側に偏位し,結腸どうしの広範な癒着および盲腸から上行結腸の大動脈前面への癒着を認めたため,癒着剥離を行った。下腸間膜動脈の走行および骨盤内に解剖異常を認めず,中枢側リンパ節郭清を伴う直腸切除術が施行可能であった。多脾症候群を伴う直腸癌に対し,腹腔鏡下切除術を行った報告は自験例が1例目であるため報告する。