Arakawa Satoshi, Morise Zenichi, Isetani Masashi, Tomishige Hirokazu, Kawabe Norihiko, Nagata Hidetoshi, Asano Yukio, Kawase Jin, Kamio Kenshiro, Imaeda Yoshihiro, Umemoto Shunji, Ikeda Masahiro, Horiguchi Akihiko
Department of Gastroenterological Surgery, School of Medicine, Fujita Health University Banbuntane Houtokukai Hospital, Nagoya, Japan.
Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan.
Asian J Endosc Surg. 2017 Nov;10(4):415-419. doi: 10.1111/ases.12378. Epub 2017 May 29.
A case of colouterine fistula caused by colonic diverticulitis that was successfully treated laparoscopically is presented. A 74-year-old woman visited us with lower abdominal discomfort and vaginal excretion with minor fecal contamination. Mild tenderness was observed in her lower abdomen. Blood examinations revealed elevated white blood cell count and C-reactive protein. Sigmoid colon diverticulitis was revealed on CT, and her condition was diagnosed as colouterine fistula. Hinchey classification was stage I. After 2 weeks of conservative therapy, her symptoms were reduced, and the white blood cell count and C-reactive protein level decreased. However, fecal contaminated vaginal excretion continued. The patient underwent laparoscopic sigmoidectomy combined with uterus excision, and she has been in good health for the 3 years since the operation. Although colouterine fistula is usually treated with open surgery, patients with controlled and well-localized inflammation may be good candidates for a laparoscopic approach.
本文介绍了一例由结肠憩室炎引起的结肠子宫瘘,经腹腔镜手术成功治疗的病例。一名74岁女性因下腹部不适及阴道排泄物有少量粪便污染前来就诊。下腹部有轻度压痛。血液检查显示白细胞计数和C反应蛋白升高。CT显示乙状结肠憩室炎,诊断为结肠子宫瘘。Hinchey分级为I期。经过2周的保守治疗,症状减轻,白细胞计数和C反应蛋白水平下降。然而,粪便污染的阴道排泄物仍持续存在。患者接受了腹腔镜乙状结肠切除术联合子宫切除术,术后3年一直健康良好。虽然结肠子宫瘘通常采用开放手术治疗,但炎症得到控制且局限良好的患者可能是腹腔镜手术的合适人选。