妊娠分娩を契機に発症した大腸全摘+回腸囊肛門（管）吻合術後 afferent limb syndrome に対する腹腔鏡下手術の1 例

Small bowel obstruction (SBO) often occurs as a postoperative complication after total proctocolectomy (TPC) and ileal pouch anal anastomosis (IPAA) for ulcerative colitis (UC). Afferent limb syndrome (ALS) is reported as a specific cause of SBO due to kinking and torsion at the proximal intestinal tract of the ileal pouch. Reported cases of ALS in Japan is rare and there have been no reports of ALS occurring after pregnancy delivery. Here, we report a case of a 25-year-old woman who underwent TPC and IPAA for UC due to refractory to medical treatments because she hoped for a future pregnancy. She gave birth spontaneously at 42 postoperative months, and a SBO developed 3 months after parturition and improved with conservative treatment. However, the symptoms repeated for a short duration, thus, we suspected intra-peritoneal adhesion as the cause of the SBO and decided to perform a laparoscopic operation. In operative findings, there was no adhesion in the abdominal cavity and the intestine of the proximal side from the ileal pouch fell into the pelvic cavity, causing kinking to the intestine. Therefore, ALS was diagnosed and we raised the proximal intestinal tract and stitched it to the abdominal wall. In this case, we speculated the ileal pouch moved to the pelvic cavity created by the contraction of the pregnant uterus after parturition. As a result, the afferent limb was severely kinked and considered to be the cause of ALS.