腟より挿入したVagi-パイプが腟壁損傷により直腸および直腸腟中隔に迷入した腹腔鏡下子宮全摘出術の２例

抄録

　Accidental rectal insertion of a vaginal delineator is an important cause of rectal injury during total laparoscopic hysterectomy (TLH). We report two cases of rectal or rectovaginal septum injury secondary to inaccurate Vagi-pipe insertion.

Case 1: A 70-year-old nullipara underwent TLH for pathological examination of endometrial thickening. Vaginal delineator placement could not be confirmed under direct vision at the time of creation of the anterior vaginal wall incision, and we immediately removed the device. Although the delineator was initially inserted into the vagina, the posterior vaginal wall was accidentally perforated and resulted in rectal injury. The rectal mucosa and vaginal wall were sutured transvaginally. The patient was discharged without any other complications, 14 days postoperatively.

Case 2: A 45-year-old virgin underwent TLH for treatment of leiomyoma after 3-month hormonal therapy. We detected a posterior vaginal wall wound at the time of creation of the anterior vaginal wall incision. Vagi-pipe insertion injured the posterior vaginal wall and resulted in placement of the device in the rectovaginal septum. The posterior vaginal wall showed two perforation sites, which were sutured transvaginally and laparoscopically. The patient was discharged without any other complications, 4 days postoperatively.

　We report two cases of complications associated with Vagi-pipe insertion. Women with a narrow vagina are at a high risk of vaginal wall injury during delineator insertion; therefore, extreme caution and alternative maneuvers are warranted in such cases.