内容紹介
Summary
A 52-year-old man whose fecal occult blood test was positive was found to have type 2 sigmoid colon cancer by colonoscopy. On enhanced barium enema study, the cecum was in the pelvis, and the ascending colon was running medially in the abdomen. Enhanced CT scan of the abdomen revealed rotation of the superior mesenteric vein(SMV). We diagnosed the case as sigmoid colon cancer(cT3N0M0, StageⅡA)with non rotation-type intestinal malrotation, and performed laparoscopic surgery. We confirmed the small intestine to be located on the right side of the abdomen, the cecum to be located in the pelvis, and the ascending colon to be running medially in the abdomen. The ascending mesocolon was adherent to the right of the sigmoid mesocolon. Following dissections of the ascending mesocolon from the sigmoid mesocolon, we performed surgery via the inside approach as usual. We dissected the root of the inferior mesenteric artery(IMA), and the operation was completed. In laparoscopic surgery for colorectal cancer with intestinal malrotation, there are some reports that it could be performed safely if attention is paid to adhesion of the mesenteries and vascular variation in the course of preoperative imaging diagnosis. We report a case of laparoscopic surgery that could be safely performed for sigmoid colon cancer with non rotation-type intestinal malrotation.
要旨
症例は52歳,男性。便潜血陽性の精査目的で施行した下部消化管内視鏡検査でS状結腸癌と診断された。注腸検査では上行結腸が腹部正中を走行し,造影CTでSMV rotation signを認めた。non rotation型の腸回転異常症を伴うS状結腸癌,cT3N0M0,StageⅡAの診断で腹腔鏡下S状結腸切除術を施行した。腹腔内を観察すると小腸は右側に存在し,上行結腸は腹部正中を走行し盲腸は骨盤内に落ち込んでいた。上行結腸間膜とS状結腸間膜の間に膜性癒着を認めたため癒着を剥離しS状結腸間膜を全体的に露出した後,通常の内側アプローチでS状結腸切除術を開始した。下腸間膜動脈根部の郭清を行い腹腔鏡下に手術を完遂した。腸回転異常を伴う大腸癌に対する腹腔鏡手術では腸間膜どうしの癒着と血管走行に留意すべきだが,術前の画像診断により安全に施行可能であったという報告が散見され,自験例を踏まえ若干の文献的考察を加え報告する。
目次
A 52-year-old man whose fecal occult blood test was positive was found to have type 2 sigmoid colon cancer by colonoscopy. On enhanced barium enema study, the cecum was in the pelvis, and the ascending colon was running medially in the abdomen. Enhanced CT scan of the abdomen revealed rotation of the superior mesenteric vein(SMV). We diagnosed the case as sigmoid colon cancer(cT3N0M0, StageⅡA)with non rotation-type intestinal malrotation, and performed laparoscopic surgery. We confirmed the small intestine to be located on the right side of the abdomen, the cecum to be located in the pelvis, and the ascending colon to be running medially in the abdomen. The ascending mesocolon was adherent to the right of the sigmoid mesocolon. Following dissections of the ascending mesocolon from the sigmoid mesocolon, we performed surgery via the inside approach as usual. We dissected the root of the inferior mesenteric artery(IMA), and the operation was completed. In laparoscopic surgery for colorectal cancer with intestinal malrotation, there are some reports that it could be performed safely if attention is paid to adhesion of the mesenteries and vascular variation in the course of preoperative imaging diagnosis. We report a case of laparoscopic surgery that could be safely performed for sigmoid colon cancer with non rotation-type intestinal malrotation.
要旨
症例は52歳,男性。便潜血陽性の精査目的で施行した下部消化管内視鏡検査でS状結腸癌と診断された。注腸検査では上行結腸が腹部正中を走行し,造影CTでSMV rotation signを認めた。non rotation型の腸回転異常症を伴うS状結腸癌,cT3N0M0,StageⅡAの診断で腹腔鏡下S状結腸切除術を施行した。腹腔内を観察すると小腸は右側に存在し,上行結腸は腹部正中を走行し盲腸は骨盤内に落ち込んでいた。上行結腸間膜とS状結腸間膜の間に膜性癒着を認めたため癒着を剥離しS状結腸間膜を全体的に露出した後,通常の内側アプローチでS状結腸切除術を開始した。下腸間膜動脈根部の郭清を行い腹腔鏡下に手術を完遂した。腸回転異常を伴う大腸癌に対する腹腔鏡手術では腸間膜どうしの癒着と血管走行に留意すべきだが,術前の画像診断により安全に施行可能であったという報告が散見され,自験例を踏まえ若干の文献的考察を加え報告する。