腹腔鏡下子宮全摘術時の腟パイプ直腸挿入による直腸損傷の1例

抄録

  We report a case of rectal injury due to accidental insertion of a vaginal delineator into the rectum during total laparoscopic hysterectomy.

  A 48-year-old nulligravid woman underwent laparoscopic hysterectomy because of excessive menstruation due to uterine fibroids. The uterine manipulator was removed before cutting the vaginal wall, and a vaginal delineator was inserted. Although there was some resistance to insertion, it was thought that the delineator was guided to the correct position under the laparoscope. We noticed accidental rectal insertion, and laparotomy was performed to repair the damaged rectum.

  The muscles of the anus relax under anesthesia, and even a vaginal delineator, which is difficult to insert without anesthesia, can be guided into the rectum easier than into the narrow vagina. Furthermore, it is difficult for the surgeon to detect incorrect insertion in laparoscopic view.