人工肛門造設状態の高齢者に対して緊急腹腔鏡下付属器切除手術を行った一例

抄録

　There have been few reports on laparoscopic surgery in the field of gynecology for patients with a stoma, and the optimal surgical procedure remains unclear. We report a case of emergency laparoscopic surgery for ovarian tumor torsion in an elderly patient with multiple underlying medical conditions, including a colostomy. The patient was 86 years old, and had multiple underlying diseases: type 2 diabetes, Parkinson’s syndrome, hypertension, hyperlipidemia, and lumbar spine compression fracture. In addition, she had undergone eight surgical procedures, including Hartmann’s operation, coronary artery bypass graft, and subdural hematoma evacuation. She presented to our hospital with left lower abdominal pain, and was diagnosed with torsion of a left ovarian cyst by CT imaging and gynecologic examination.

　Due to her advanced age and multiple comorbidities, we opted for a relatively minimally invasive procedure, performing laparoscopic bilateral salpingo oophorectomy. Given her history of midline abdominal incision extending to the umbilicus and the presence of a colostomy in the left lower abdomen, we inserted the first port using an open technique at Palmer’s point to avoid organ injury, and then placed the other ports in safe positions under direct observation within the abdominal cavity. The surgeon stood on the patient’s right side and completed the surgery without complications using the right parallel technique. It is essential to consider port placement according to the case in laparoscopic surgery following stoma creation or open surgery, particularly the selection of the first puncture site, which is important for avoiding complications.