回腸局所癒着により発症した腹腔鏡下単純子宮全摘術後の絞扼性腸閉塞―開腹手術後との癒着形態の違いに注目する―

抄録

Background: Adhesions occurring after laparoscopic surgery are observed to be more localized than those after open surgery. However, whether the increased use of laparoscopic surgery has translated into fewer adhesion-related postoperative complications remains unclear. Notably, focal adhesions may cause more severe complications. We report a case of strangulated small bowel obstruction (SBO) secondary to focal adhesions occurring after total laparoscopic hysterectomy (TLH).

Case: A 39-year-old woman without a history of abdominal surgery underwent TLH for the management of a leiomyoma. She had uncomplicated intra- and postoperative course and discharged on postoperative day (POD) 3. On POD 37, she was admitted to the hospital with sudden onset of abdominal pain. Based on contrast-enhanced computed tomography and arterial blood gas analysis that revealed metabolic acidosis, we clinically suspected strangulated SBO. Emergency exploratory laparoscopy was performed, and intraoperatively we identified strangulated SBO secondary to ileo-ileal adhesions. Laparoscopic adhesiolysis was performed. Intestinal resection was not indicated because the previously diminished blood flow recovered after adhesiolysis. She was discharged on POD 9 of her second hospitalization following an uneventful course.

Conclusion: Strangulated SBO secondary to focal adhesions is a need-to-know complication after laparoscopic surgery. Immediate diagnosis of bowel ischemia and surgical treatment are essential.