A case of rectal endometriosis treated with laparoscopic high anterior resection

今回我々は術前診断が困難であった腸管子宮内膜症を経験したので,若干の文献的考察を加え報告する.症例は49歳,女性.健診にて便潜血陽性を指摘され,近医を受診.下部消化管内視鏡検査にて直腸Rsに1型腫瘍を指摘され,精査加療目的に当科を紹介された.当院で3回行った内視鏡では粘膜下腫瘍様であり,生検で確定診断に至らなかった.悪性疾患の否定ができず,患者の同意が得られたため,腹腔鏡下高位前方切除術を施行した.術中所見では骨盤腔内は白色調で強固に癒着していた.切除標本は粘膜下腫瘍様であり,病理診断にて腸管子宮内膜症と診断された.術後は縫合不全を合併したが,保存的に軽快した.

We encountered a case of intestinal endometriosis with difficulty in preoperative diagnosis. Here we report the case with some literature review.The patient was a 49-year-old woman. She visited a nearby doctor due to the positive result of fecal occult blood test at a medical check-up. She was referred to our department for detailed examination and received treatment because a type 1 tumor was suspected in the rectum Rs by lower gastrointestinal endoscopy. Three times of endoscopic exams performed in our hospital revealed that submucosal tumor-like appearance was seen in the rectum, however biopsy did not lead to definitive diagnosis. Since the possibility of malignancy could not be denied and the patient strongly desired to receive operation, laparoscopic high anterior resection was performed. In the intraoperative findings, the pelvic cavity was white tone and the endometrium was firmly adhered to the rectum. The resected specimen showed a submucosal tumor, and intestinal endometriosis was confirmed with pathological diagnosis.

腸管子宮内膜症

腹腔鏡手術

直腸腫瘍