腸重積にて15年間腹痛を繰り返しダブルバルーン小腸内視鏡で発見されたMeckel憩室の1例

Meckel's Diverticulum which had Caused Frequent Intussusception over a Period of 15 Years was Diagnosed by Double Balloon Enteroscopy, Report of a Case

要旨　患者は28歳，女性．中学生のころより数か月に1度の頻度で腹痛が出現していたが，いつも数日で軽快するため様子をみていた．同様の腹痛が出現したため近医受診し，腹部超音波検査にて小腸の腸重積と診断され，経口小腸透視にて回腸に粘膜不整領域が発見された．当院で行ったダブルバルーン小腸内視鏡検査にて回盲部から60cm口側の腸間膜対側に径2cmほどの憩室を認めMeckel憩室と診断した．内視鏡下で点墨を行い，待機的に腹腔鏡補助下回腸部分切除術を施行した．若年者の腸重積を来す小腸疾患では，Meckel憩室も考慮すべきであり，Meckel憩室の診断と治療においてはダブルバルーン小腸内視鏡検査が有用であると考えられた．

　The case is that of a 28-year-old woman. She had had acute and frequent abdominal pain once every few months from her time as a junior high school student, but, since the pain would recede after a few days, she was being watched. A check-up was carried out by a local doctor, and small intestinal invagination was diagnosed after abdominal ultrasonography, and an irregular mucosal area was discovered in the ileum by oral small intestine observation. She was admitted to our hospital for investigation of the cause of the invagination. We performed double balloon enteroscopy（DBE）and found the orifice of a diverticulum with a diameter of about 2cm in the ileum, about 60cm from the ileocecal valve. We confirmed the existence of a gastric fundal gland by biopsy and diagnosed it as a Meckel's diverticulum. We performed tattooing under endoscope and performed peritoneoscope-assisted lower ileum partial excision after waiting for a time. For invagination in the small bowel of a young person, we should have considered the existence of a Meckel's diverticulum, and it was thought that double balloon enteroscopy in the small intestine was useful for diagnosis and treatment of the Meckel's diverticulum.