図１１と図１２で下行結腸（DC）は虚脱し上行結腸（AC）は拡張しているので図１０の1から肛門側へ追跡する．図６の25あたりから横行結腸の後壁が肥厚し始め（△），図２〜図９で腫瘤を形成する（▲）．腫瘤は大きく，図２〜図９までと長さも7cmほどあり，図３〜図５では周囲脂肪組織の濃度上昇（↑）もあるが，腫瘍性病変か炎症性病変かの判断は単純CTでは困難である．腫瘤実質の濃度が高いことは腫瘍性病変を示唆し，大きさと周囲脂肪組織の濃度上昇は炎症性病変を示唆するが，腫瘍の穿孔の可能性も否定できない．大腸ファイバー検査で悪性腫瘍所見を呈していたので経肛門的に減圧チューブを挿入した（図A）．図１７と図１８で回腸末端（TI）と周囲の小腸の拡張がないことは，Bauhin弁が機能していて大腸内容物が逆流するのを妨げていることを意味し，拡張した大腸が穿孔しやすい危険な徴候である．

文献考察：大腸閉塞例に経肛門的減圧法、36例中34例（94.4%）に成功
Dis Colon Rectum. 2001 Mar;44(3):418-22.
Endoscopic transanal decompression with a drainage tube for acute colonic obstruction: clinical aspects of preoperative treatment.
Tanaka T, Furukawa A, Murata K, Sakamoto T.

PURPOSE: The study was undertaken to evaluate the clinical usefulness of endoscopic transanal decompression with a newly developed drainage tube for the treatment of acute colonic obstruction. METHODS: Thirty-six patients ranging in age from 46 to 87 years (average age = 69 years) with acute colorectal obstruction secondary to carcinoma were treated by means of intubation with a flexible drainage tube using combined endoscopic and fluoroscopic guidance. After tube placement, the obstructed colon was aspirated, decompressed, and cleaned with a 50 ml syringe and saline solution. The drainage tube was kept inserted and the colon was irrigated two or three times per day using 500 to 1,000 ml of saline until there were no contents in the colon. The colon was almost empty at the time of operation. The success rate, benefits, and complications of this technique were evaluated. RESULTS: Placement of the drainage tube was successful in 34 (94.4 percent) of 36 patients. Immediately after aspiration and decompression, symptoms related to obstruction were relieved in 21 patients (61.8 percent), within one hour in 9 patients (26.5 percent) and within four hours in 4 patients (11.8 percent). All 34 patients had elective single-stage surgery without severe complications at the anastomotic site such as anastomotic leakage and postanastomotic stenosis that needed treatment a few days after placement of the drainage tube. In the two cases of unsuccessful placement of the drainage tube, emergent colostomy was performed. CONCLUSION: Decompression with a transanal drainage tube is an easy and safe technique to relieve colonic obstruction effectively without any excess burden to patients. Because the procedure permits single-stage surgery in most cases, it is also cost effective.　　　　　　　　PMID: 11289290