内容紹介
A Case of Ischemic Colitis Four Months after Laparoscopic Left Hemicolectomy Preserving Superior Rectal Artery
Summary
The case was for a male at the age of 80. We performed laparoscopic left hemicolectomy and D3 lymph node dissection for descending colon cancer. He had a good postoperative prognosis and was discharged on the 14th day after the operation. Later, he was receiving the treatment on an outpatient basis without postoperative adjuvant chemotherapy during the follow-up period. He visited the hospital for sudden abdominal pain and melena as chief complaint approximately 4 months after the operation. We found prominent edematous wall thickening and increased surrounding fat concentration in the anal side of colon from the anastomosis site with plain abdominal CT scan. We also found that the anal side of colon from the anastomosis site an edematous change broadly in the lower gastrointestinal endoscopy. We conducted conservative treatment with the diagnosis of ischemic colitis at the anal side of colon from the anastomosis site. He was discharged on the 11th day after the hospitalization. Later, we conducted a follow-up examination for him on an outpatient basis. We recognized the symptom improvement approximately 2 months after the onset of the ischemic colitis.
要旨
症例は80歳,男性。下行結腸癌(T3,N0,M0,StageⅡ)に対して上直腸動脈を温存した腹腔鏡下結腸左半切除術,D3リンパ節郭清術を施行した。術後経過は良好であり,術後14日目に退院した。その後外来にて術後補助化学療法なしで,経過観察中であった。術後約4か月後に突然の腹痛と下血を主訴に来院した。精査の腹部単純CT検査で,吻合部より肛門側の腸管に著明な浮腫性壁肥厚と周囲脂肪織濃度の上昇を認めた。下部消化管内視鏡検査では,同様に吻合部より肛門側の腸管粘膜が広範に浮腫性変化を来していた。以上より,吻合部肛門側の虚血性腸炎の診断で保存的加療を行った。絶食,補液管理にて症状が改善し,第11病日で退院可能となった。その後外来にて経過観察を行い,発症後約2か月で症状軽快を認めた。
目次
Summary
The case was for a male at the age of 80. We performed laparoscopic left hemicolectomy and D3 lymph node dissection for descending colon cancer. He had a good postoperative prognosis and was discharged on the 14th day after the operation. Later, he was receiving the treatment on an outpatient basis without postoperative adjuvant chemotherapy during the follow-up period. He visited the hospital for sudden abdominal pain and melena as chief complaint approximately 4 months after the operation. We found prominent edematous wall thickening and increased surrounding fat concentration in the anal side of colon from the anastomosis site with plain abdominal CT scan. We also found that the anal side of colon from the anastomosis site an edematous change broadly in the lower gastrointestinal endoscopy. We conducted conservative treatment with the diagnosis of ischemic colitis at the anal side of colon from the anastomosis site. He was discharged on the 11th day after the hospitalization. Later, we conducted a follow-up examination for him on an outpatient basis. We recognized the symptom improvement approximately 2 months after the onset of the ischemic colitis.
要旨
症例は80歳,男性。下行結腸癌(T3,N0,M0,StageⅡ)に対して上直腸動脈を温存した腹腔鏡下結腸左半切除術,D3リンパ節郭清術を施行した。術後経過は良好であり,術後14日目に退院した。その後外来にて術後補助化学療法なしで,経過観察中であった。術後約4か月後に突然の腹痛と下血を主訴に来院した。精査の腹部単純CT検査で,吻合部より肛門側の腸管に著明な浮腫性壁肥厚と周囲脂肪織濃度の上昇を認めた。下部消化管内視鏡検査では,同様に吻合部より肛門側の腸管粘膜が広範に浮腫性変化を来していた。以上より,吻合部肛門側の虚血性腸炎の診断で保存的加療を行った。絶食,補液管理にて症状が改善し,第11病日で退院可能となった。その後外来にて経過観察を行い,発症後約2か月で症状軽快を認めた。