内翻Meckel憩室を先進部とする腸重積症の1例

Invagination due to Inversion of Meckel's Diverticulum, Report of a Case

要旨　患者は29歳，男性．腹痛と下血の精査のため当院を紹介受診した．小腸X線検査で回腸にKerckring皺襞様ひだを有するペニス様腫瘤像を認め，体外式超音波検査では比較的均一な高エコー像を内部に有する有茎性の腫瘤性病変として描出された．術中内視鏡検査では腫瘤の頭部の表面は軽度発赤した過形成性粘膜から成っており，茎部は正常の小腸粘膜に覆われていた．摘出された病変の大きさは7×3cmで，回盲弁から70cm口側の腸管膜対側に存在した．病理組織学的に同腫瘤は腸管壁で構成され，それが漿膜側脂肪組織とともに腸管内腔へ内翻した真性憩室の形態をとっていた．以上から内翻Meckel憩室を先進部とする腸重積症と診断した．

　A 29-year-old man was admitted to our hospital, complaining of abdominal pain and melena. A small intestinal x-ray series demonstrated an abnormal penis-like appearance with folds on its stalk in the distal ileum. Ultrasonography showed a pedunculated tumor with a relatively homogeneous high echoic lesion in the ileum. Endoscopical examination during revealed that the surface of the tumor's head was hyperplastic mucosae. An ulceration was observed on its top. Partial resection of the ileum was performed. The penis-like tumor that developed from the opposite site of the mesenterium was 7 cm in length. Histological section revealed that had the tumor was a inverted Meckel's diverticulum.