ダブルバルーン小腸内視鏡にて観察しえたMeckel憩室の1例

Meckel's Diverticulum Diagnosed by Double-balloon Enteroscopy, Report of a Case

要旨　患者は31歳，男性．下血後の意識消失にて弘前市立病院入院．諸検査の結果，小腸出血が疑われ当科紹介．^99mTcO₄－シンチグラフィーで臍下部に異常集積像を認め，ダブルバルーン小腸内視鏡検査を施行したところ回腸に憩室が観察され，Meckel憩室と診断した．術中所見では，回腸末端より口側85cmの腸間膜対側に10×2cmの憩室が確認された．病理組織学的には真性憩室で，異所性胃粘膜および膵組織を伴っていた．術前の下部消化管内視鏡検査では確認できなかったが，ダブルバルーン小腸内視鏡を用いることによって診断が可能であった．ダブルバルーン小腸内視鏡は通常の内視鏡検査で出血源がわからない消化管出血に対し有用であると考えられた．

　A 31-year-old man with bloody stool was admitted to our hospital. He lost consciousness transiently due to massive bleeding. We could not identify the bleeding focus by esophagogastroduodenoscopy and total colonoscopy. ^99mTcO₄－ pertechnetate scintigraphy revealed abnormal accumulation under the umbilicus that was suspected as Meckel's diverticulum. Because of this, we performed double-balloon enteroscopy (DBE) and found the orifice of the diverticulum in the ileum. We also used radiography and finally diagnosed it as Meckel's.

　The patient underwent resection of the Meckel's diverticulum about fortnight later. The diverticulum was 10×2cm in size on the opposite side of the mesentery, about 85cm oral from ileocecal valve. The resected specimen showed that the lesion had proper muscle layer and ectopic gastric mucosa and pancreatic tissue, which was consistent with Meckel's diverticulum. Though it has been very difficult to diagnose Meckel's diverticulum so far, DBE enables us to diagnose it preoperatively.