Fujinaga Atsuro, Akagi Tomonori, Etoh Tsuyoshi, Tada Kazuhiro, Itai Yusuke, Kono Yohei, Hiratsuka Takahiro, Suzuki Kosuke, Shibata Tomotaka, Ueda Yoshitake, Toujigamori Manabu, Shiroshita Hidefumi, Shiraishi Norio, Inomata Masafumi
Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan.
Department of Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, Oita, Japan.
Surg Case Rep. 2020 Feb 3;6(1):33. doi: 10.1186/s40792-020-0798-z.
Although obstructive colitis with colon cancer is not a rare disease, most cases can be improved with conservative therapy. We report a case of a patient who underwent a laparoscopic two-stage operation for rectal cancer with refractory obstructive colitis after kidney transplantation.
The patient was a 71-year-old man taking immunosuppressants who had previously undergone right living kidney transplantation for chronic nephritis. He presented to hospital complaining of abdominal pain and was diagnosed as having rectal cancer with obstructive colitis. Although conservative therapy by fasting was continued for 5 weeks, his obstructive colitis did not improve. Therefore, we decided to perform a two-stage operation. First, we performed a laparoscopic Hartmann's operation. It took 6 months for his obstructive colitis to improve after this operation, and then we performed a laparoscopic colorectal anastomosis. There were no postoperative complications in either operation.
A laparoscopic two-stage operation could be one of the operative options to reduce postoperative complications in patients with comorbidities such as taking immunosuppressants.
尽管伴有结肠癌的梗阻性结肠炎并非罕见疾病，但大多数病例通过保守治疗可得到改善。我们报告一例肾移植后患有难治性梗阻性结肠炎的直肠癌患者接受腹腔镜两阶段手术的病例。
该患者为一名71岁男性，正在服用免疫抑制剂，此前因慢性肾炎接受了活体右肾移植。他因腹痛入院，被诊断为患有伴有梗阻性结肠炎的直肠癌。尽管禁食保守治疗持续了5周，但他的梗阻性结肠炎并未改善。因此，我们决定进行两阶段手术。首先，我们进行了腹腔镜Hartmann手术。该手术后他的梗阻性结肠炎用了6个月才改善，然后我们进行了腹腔镜结直肠吻合术。两次手术均无术后并发症。
腹腔镜两阶段手术可能是减少如服用免疫抑制剂等合并症患者术后并发症的手术选择之一。
