内容紹介
Summary
We report a case where home discharge was possible after laparoscopic Hartmann's operation for superior elderly perforation of rectal cancer. The patient was 91-year-old, a woman. She was delivered to the emergency room complaining of weakness. We diagnosed rectal perforation and started emergency laparoscopic surgery. Rectal cancer perforation was observed during surgery and laparoscopic Hartmann's operation plus D2 lymph node dissection was performed. The operation time was 3 hours 21 minutes, the blood loss was 10 g. She resumed her meal intake from the postoperative day(POD)5 and became ready for discharge on POD 20 postoperatively. She moved to a comprehensive care ward and she was discharged to her house on POD 89. On POD 120, she visited the hospital complaining of anorexia and anal bleeding, and was diagnosed as local recurrence in the pelvis, multiple liver metastases, and cancerous peritonitis. She was admitted to palliative care unit on POD 132 and died on POD 141. It was suggested that laparoscopic surgery will be minimally invasive even at superior elderly patients and that they will be able to discharge from their homes.
要旨
超高齢者の直腸癌穿孔に対して腹腔鏡下Hartmann手術を施行し,自宅退院が可能となった症例を経験したので報告する。症例は91歳,女性。衰弱を主訴として当院へ救急搬送され,直腸穿孔の診断で緊急手術となった。通常の直腸手術に準じた5ポートで手術を開始した。術中所見により直腸癌穿孔と診断し,腹腔鏡下Hartmann手術+D2リンパ節郭清を行った。手術時間3時間21分,出血量は10 gであった。術後5日目から食事摂取を再開し,術後20日目に当科としては退院可能な状態となったが地域包括ケア病棟に転棟し,術後89日目に自宅退院となった。術後120日目に食欲不振と肛門出血を主訴に外来を受診し,骨盤内局所再発,多発肝転移,癌性腹膜炎と診断された。術後132日目に緩和ケア病棟に入院となり,術後141日目に死亡した。超高齢者であっても腹腔鏡下手術を選択することで低侵襲となり,自宅退院が可能となったと考えられた。
目次
We report a case where home discharge was possible after laparoscopic Hartmann's operation for superior elderly perforation of rectal cancer. The patient was 91-year-old, a woman. She was delivered to the emergency room complaining of weakness. We diagnosed rectal perforation and started emergency laparoscopic surgery. Rectal cancer perforation was observed during surgery and laparoscopic Hartmann's operation plus D2 lymph node dissection was performed. The operation time was 3 hours 21 minutes, the blood loss was 10 g. She resumed her meal intake from the postoperative day(POD)5 and became ready for discharge on POD 20 postoperatively. She moved to a comprehensive care ward and she was discharged to her house on POD 89. On POD 120, she visited the hospital complaining of anorexia and anal bleeding, and was diagnosed as local recurrence in the pelvis, multiple liver metastases, and cancerous peritonitis. She was admitted to palliative care unit on POD 132 and died on POD 141. It was suggested that laparoscopic surgery will be minimally invasive even at superior elderly patients and that they will be able to discharge from their homes.
要旨
超高齢者の直腸癌穿孔に対して腹腔鏡下Hartmann手術を施行し,自宅退院が可能となった症例を経験したので報告する。症例は91歳,女性。衰弱を主訴として当院へ救急搬送され,直腸穿孔の診断で緊急手術となった。通常の直腸手術に準じた5ポートで手術を開始した。術中所見により直腸癌穿孔と診断し,腹腔鏡下Hartmann手術+D2リンパ節郭清を行った。手術時間3時間21分,出血量は10 gであった。術後5日目から食事摂取を再開し,術後20日目に当科としては退院可能な状態となったが地域包括ケア病棟に転棟し,術後89日目に自宅退院となった。術後120日目に食欲不振と肛門出血を主訴に外来を受診し,骨盤内局所再発,多発肝転移,癌性腹膜炎と診断された。術後132日目に緩和ケア病棟に入院となり,術後141日目に死亡した。超高齢者であっても腹腔鏡下手術を選択することで低侵襲となり,自宅退院が可能となったと考えられた。