盲腸膜様閉鎖症の1例

Membranous Atresia of the Cecum, Report of a Case

要旨　患者は75歳，男性．主訴は右下腹部不快感．腹部単純写真で右下腹部に糞石様の石灰化陰影がみられ，注腸でこの陰影の上部を取り囲むようにバリウムは入るが，下部にはバリウムは流入しない．虫垂は描出されない．colonofiberscopyで粘膜下腫瘤の像を呈する．摘出された盲腸の内腔は上行結腸との間に正常粘膜を有する膜様形式によって囊状となり，径5mmの小孔により結腸と連続していた．内腔はバリウム便が充満していた．先天性結腸閉鎖の成因は血行障害説が定説となっているが本例は十二指腸閉鎖の成因と考えられている発生異常説を支持する1症例として，この論争に一石を投じるものとして報告した．

　A 75-year-old man was admitted to our hospital complaining of right lower abdominal discomfort. A plain film of the abdomen demonstrated a calcified shadow like a fecal stone in the right lower area of the abdomen. Barium enema showed this mass was outside of the colon and appendix was not demonstrated. Colonofiberscopy showed that it resembled a submucosal tumor. The resected cecum revealed that the cecum was separated from the ascending colon with a membrane with normal mucosa, communicating with the ascending colon by a small hole, and filled with barium feces. It was diagosed as a congenital membranous atresia of the cecum. Most reports support the vascular theory as the cause of colonal atresia but this case supports the recanalization-disturbance theory.