腹腔鏡下直腸低位前方切除術を施行し自然妊娠に至った不妊症を伴う直腸子宮内膜症の1例

抄録

　Bowel endometriosis is one of the most severe forms of endometriosis and accounts for the highest incidence of endometriotic lesions at atypical sites. Although medical therapy is recommended as treatment for rectal endometriosis, surgical therapy is considered in patients with infertility. We report a case of rectal endometriosis with infertility in a patient who underwent laparoscopic rectal low anterior resection that was followed by spontaneous pregnancy.

　A 27-year-old nulligravida with infertility observed over 2 years after discontinuation of hormonal agent use was referred to our hospital with abdominal pain and melena that worsened during menstruation. Following detailed examination and investigations, she was diagnosed with bilateral ovarian endometriotic cysts and rectal endometriosis. We initiated infertility treatment, including assisted reproductive techniques; however, she could not conceive for a year. Laparoscopic rectal low anterior resection was performed owing to worsening endometriotic lesions and the development of intestinal stricture. Her postoperative course was uneventful, and she conceived spontaneously 2 months postoperatively with a vaginal delivery at term.

　Several recent studies have reported that surgical treatment for rectal endometriosis improves fertility. Following are the indications for surgical treatment for rectal endometriosis: (1) intestinal stenosis and melena, (2) pain refractory to conservative management, (3) lesions refractory to hormone therapy, (4) infertility and, (5) suspected malignancy. Laparoscopic intestinal resection could be considered a useful initial therapeutic approach, particularly in patients aged ≤35 years without uterine adenomyosis.