内容紹介
Summary
A 72-year-old woman who underwent colorectal endoscopy because of positive fecal occult blood test results was diagnosed with ascending colon cancer. Preoperative CT revealed advanced ascending colon cancer and portosystemic shunt between the ileocecal vein and inferior vena cava. It was necessary to cut the shunt when ileocecal resection was performed. The patient had no symptoms caused by the shunt, and blood examination results showed no liver enzyme abnormalities. Abdominal ultrasound examination revealed no liver cirrhosis and normal blood flow in the portal vein and shunt flow from the ileocecal vein to the inferior vena cava. We assessed that surgery could be safely performed without increasing portal vein pressure. Laparoscopic ileocecal resection was performed by cutting the shunt. Partial jejunum resection was also performed for a mesenteric tumor observed intraoperatively, and pathological findings revealed a lymphangioma. The patient was discharged home on postoperative day 7 without any symptoms, liver enzyme abnormalities, or ascites suggestive of increased portal vein pressure on abdominal ultrasound examination. Colorectal cancer surgery with simultaneous cutting of a portosystemic shunt has rarely been reported. It is necessary to consider the causes of portosystemic shunt and then cut the shunt during surgery when needed.
要旨
症例は72歳,女性。便潜血陽性に対する下部消化管内視鏡検査で上行結腸癌を指摘され,当院に紹介された。胸腹部造影CT検査にて回結腸静脈と下大静脈間に門脈体循環シャントを認め,大腸癌手術に際してシャント血管の切離は不可避であった。無症候性で,血液検査で肝機能異常や腹部超音波検査で明らかな肝硬変は認めず,門脈血の流速は正常範囲であった。シャント血管切離による門脈圧亢進の可能性は低いと判断し,腹腔鏡下回盲部切除術を施行した。術中に空腸間膜腫瘍を認め空腸部分切除も併施し,後の病理検査で腸間膜リンパ管腫症と診断された。術後経過良好で,肝機能異常を認めず術後7日目に軽快退院した。切離が必要な門脈体循環シャントを有する大腸癌症例に対する手術症例はまれで報告も少ない。大腸癌手術に際し切離が必要な門脈体循環シャントは,その成因に注意し手術を施行する必要があると考えられた。
目次
A 72-year-old woman who underwent colorectal endoscopy because of positive fecal occult blood test results was diagnosed with ascending colon cancer. Preoperative CT revealed advanced ascending colon cancer and portosystemic shunt between the ileocecal vein and inferior vena cava. It was necessary to cut the shunt when ileocecal resection was performed. The patient had no symptoms caused by the shunt, and blood examination results showed no liver enzyme abnormalities. Abdominal ultrasound examination revealed no liver cirrhosis and normal blood flow in the portal vein and shunt flow from the ileocecal vein to the inferior vena cava. We assessed that surgery could be safely performed without increasing portal vein pressure. Laparoscopic ileocecal resection was performed by cutting the shunt. Partial jejunum resection was also performed for a mesenteric tumor observed intraoperatively, and pathological findings revealed a lymphangioma. The patient was discharged home on postoperative day 7 without any symptoms, liver enzyme abnormalities, or ascites suggestive of increased portal vein pressure on abdominal ultrasound examination. Colorectal cancer surgery with simultaneous cutting of a portosystemic shunt has rarely been reported. It is necessary to consider the causes of portosystemic shunt and then cut the shunt during surgery when needed.
要旨
症例は72歳,女性。便潜血陽性に対する下部消化管内視鏡検査で上行結腸癌を指摘され,当院に紹介された。胸腹部造影CT検査にて回結腸静脈と下大静脈間に門脈体循環シャントを認め,大腸癌手術に際してシャント血管の切離は不可避であった。無症候性で,血液検査で肝機能異常や腹部超音波検査で明らかな肝硬変は認めず,門脈血の流速は正常範囲であった。シャント血管切離による門脈圧亢進の可能性は低いと判断し,腹腔鏡下回盲部切除術を施行した。術中に空腸間膜腫瘍を認め空腸部分切除も併施し,後の病理検査で腸間膜リンパ管腫症と診断された。術後経過良好で,肝機能異常を認めず術後7日目に軽快退院した。切離が必要な門脈体循環シャントを有する大腸癌症例に対する手術症例はまれで報告も少ない。大腸癌手術に際し切離が必要な門脈体循環シャントは,その成因に注意し手術を施行する必要があると考えられた。