Matsuda Keiji, Suda Kazufumi, Tamura Kazuo, Deguchi Tomoaki, Yamazaki Eriko, Yago Hiroshi, Inaba Tsuyoshi, Takeshima Toshio, Adachi Miki, Okinaga Kota
Deparment of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-0003, Japan.
Surg Today. 2003;33(10):768-71. doi: 10.1007/s00595-003-2579-2.
A 67-year-old man was admitted for investigation of bloody stools. The sigmoid colon was found to be intussuscepted into the rectum very close to the anus, making reduction difficult. After dividing the peritoneum, the surgeon inserted his hands below the peritoneal reflection along the rectum and pushed the intussusceptum back from the distal to the proximal rectum using a milking action. The rectum was divided 5 cm from the peritoneal reflection, and the sigmoid colon was divided 10 cm proximally from the intussusception. The proximal end of the sigmoid colon was brought out as a colostomy. The residual rectum and the descending colon were anastomosed 5 months after the first operation. We present a case of adult intussusception of the sigmoid colon caused by a well-differentiated adenocarcinoma, which was successfully treated by manually reducing the intussusception, whereby abdominoperineal resection was avoided.
一名67岁男性因便血入院检查。发现乙状结肠套叠至距肛门很近的直肠内,复位困难。在切开腹膜后,外科医生将手沿直肠插入腹膜返折下方,通过挤奶样动作将套叠肠管从直肠远端向近端推回。在距腹膜返折5cm处切断直肠,在套叠近端10cm处切断乙状结肠。将乙状结肠近端引出作为结肠造口。首次手术后5个月,将残留直肠与降结肠进行吻合。我们报告一例由高分化腺癌引起的成人乙状结肠套叠病例,通过手动复位成功治疗,避免了腹会阴联合切除术。