A Case of Idiopathic Perforation in the Stoma Limb 19 years after Colostomy
- 1 January 2021
- journal article
- Published by Japan Society of Coloproctology in Nippon Daicho Komonbyo Gakkai Zasshi
- Vol. 74 (6), 369-373
- https://doi.org/10.3862/jcoloproctology.74.369
Abstract
症例：91歳，女性．主訴：腹痛．現病歴：強い腹痛を主訴に前医を受診し，消化管穿孔に伴う汎発性腹膜炎が疑われ，手術目的に当院紹介となった．既往歴：直腸癌（Hartmann手術：72歳）．意識清明．血圧116/58mmHg，HR68回/分．ストーマ周囲に反跳痛を伴う強い圧痛あり．腹部CT：ストーマ周囲の腹壁内に便塊と腸管外ガスを認め,人工肛門脚部穿孔と診断し緊急手術を施行した．術中所見でS状結腸間膜側に約20mm径の穿孔を認めたが，糞便は間膜内に限局しており，腹壁内に便の流出はなかった．穿孔部を切除し，新たに横行結腸ストーマを造設した．術後経過は良好で，第22病日に転院した．病理組織学的検査で特発性大腸人工肛門脚部穿孔と診断した．本邦では人工肛門患者での特発性大腸穿孔は自験例を含め7例報告されているが，本症例のように人工肛門造設後晩期に発症した報告はなかった．若干の文献的考察とともに報告する．Keywords
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