ホジキンリンパ腫の治療中に発症した腸閉塞に腹腔鏡補助下解除術を施行 した1例

A ４０-year-old woman with stage４B Hodgkin’ s lymphoma（HL）developed small bowel obstruction during chemotherapy. The tip of long tube reached the part of stenosis and radiology and abdominal CT scan revealed a beak-like stenosis. An incarcerated internal hernia associated with strangulation or a simple adhesive intestinal obstruction was suspected and laparoscopic surgery was performed. The laparoscopic findings showed adhesion and traction of the contralateral side of mesenterium and strangulation which also intricately banded the collapsed loops of the ileum. The resected tissues showed a fibrotic stenosis of the small bowel and the greater omentum with infiltration of HL. This severe stenosis could finally be recognized by extracorporeal examination through a minor laparotomy. Laparoscopic surgery was useful procedure to observe the site of obstruction and transect complex strangulations, however more ingenuity of surgical procedure and more careful observation are essential to reliably achieve laparoscopic surgery for the small bowel obstruction.