内翻した小腸消化管重複症の1例

Inverted Duplication of the Alimentary Tract, Report of a Case

要旨　患者は50歳，男性．下腹部痛，黒色便を主訴にて来院し，上部消化管内視鏡検査，全大腸内視鏡検査にて，出血源は明らかではなかった．出血シンチグラフィで小腸からの出血が疑われたため，小腸造影検査を施行したところ，隆起性病変を認めたため小腸部分切除術を施行．回腸末端より約78cmの回腸に腫瘤を先進部とする腸重積を認め，病理組織学的には，消化管重複症の内翻と診断した．

　A 50-year-old man was admitted to our hospital, complaining of lower abdominal pain and tarry stool. The sourse of bleeding was detected neither by gastro-intestinal-panendoscopy nor by total colonoscopy. 99 mTc HSA-DTPA scintigraphy showed a hot spot in the ileum and movement on the spot. Barium-enema study revealed that a smooth-surfaced elevated lesion was located in the ileum. The patient was operated on under the diagnosis of a tumor in the small intestine. Partial resection of the ileum was performed. An intussusception was found in the ileal lumen, 78cm from the terminal portion, with a protruding lesion at the top. The histology of the resected specimen revealed inverted duplication of the alimentary tract.

　1) Department of Internal Medicine, Saiseikai Nara Hospital, Nara, Japan