図１で上行結腸（AC）も下行結腸（DC）も拡張しているので，図２の1から肛門側へ，壁所見の変化に気をつけながら追跡すると，図１４のS状結腸13と図１５の14で壁が乳頭状の病変となり（▲），そこが閉塞部位であることがわかる．病変（▲）はよく造影され，図１３と図１４のS状結腸15と16，直腸17と18と比べて腫大しており，S状結腸癌による大腸閉塞と診断する．経肛門的減圧を試みたが成功せず，経鼻胃管を挿入した． 図Aは2日後のＣＴ（図７と同部位）で，小腸拡張が著明になり，盲腸の拡張も増大している．大腸閉塞においては経鼻胃管による減圧では不十分で危険である．盲腸に人工肛門を造設し，後日Ｓ状結腸切除を行った．手術及び病理所見：Ｓ状結腸癌．moderately differentiated adenocarcinoma，stage IIIb．

文献考察：大腸閉塞例に経鼻的イレウスチューブによる減圧成功例は44.4%と低い
Hepatogastroenterology. 1999 Sep-Oct;46(29):2835-8.
Study of long intestinal tube for decompression of obstructive left colon cancer

BACKGROUND/AIMS: Recently, several reports have recommended primary resection, rather than a staged operation, for obstructive left colon cancer. However pre-operative decompression is important for reducing complications and improving the curability of primary resection. Among the many pre-operative decompression strategies reported, we selected the long intestinal tube and evaluated the effectiveness of this convenient strategy. METHODOLOGY: A long intestinal tube was inserted pre-operatively for decompression in 27 of 29 patients undergoing resection for obstructive left colon cancer (1991-1995). We retrospectively studied the clinical features (responders vs. non-responders) of the 27 patients. We also compared these 27 with 26 other pre-1990 patients, who did not receive pre-operative decompression, in term of post-operative morbidity. RESULTS: Twelve of the 27 patients were responders; success rate 44.4%. There were no blood profile differences between responders and non-responders, but the time from bowel movement cessation to intestinal tube insertion was 3 days or less in all responders but 4 days or more in non-responders (p