2017 年 33 巻 1 号 p. 156-161
The goal of primary debulking surgery (PDS) in ovarian cancer is to achieve complete resection of the tumors. There are, however, many complications after this surgery, because of its invasiveness. Small bowel obstruction is one of the major complications of PDS. The rate of incidence of small bowel obstruction after PDS has been reported as 30%. While adhesive small bowel obstruction has traditionally been managed via the open approach, it often induces another adhesive small bowel obstruction after surgery. Therefore, patients with small bowel obstruction may benefit from the laparoscopic approach due to its low invasiveness. We report a case of laparoscopically assisted surgery performed for adhesive small bowel obstruction following PDS. A 48-year old woman had small bowel obstruction 10 days post-PDS. Twenty days after the surgery, she developed septic shock and disseminated intravascular coagulation (DIC) due to bacterial translocation from the small bowel obstruction. After recovering from the septic shock and DIC, we performed a laparoscopically assisted surgery to relieve the adhesions of the small bowel obstruction. Surgery was performed using the GelPOINT® advanced platform as the main platform. There were many severe adhesions between the small bowel, pelvic wall and the sigmoid colon. We successfully relieved most of the adhesions by laparoscopic surgery, and directly repaired the defective parts of the serosa of the small bowel, accessing them from the small incision part of the main platform. The patient recovered well without recurrence of either the small bowel obstruction or the ovarian cancer. Due to its decreased degree of invasiveness, laparoscopic surgery, rather than open surgery, might be more appropriate when treating adhesive small bowel obstruction.
