術前診断しえた空腸憩室部小腸癌の1例

Jejunal Cancer Associated with Diverticula of the Jejunum

要旨　患者は77歳，男性．心窩部痛と食思不振が出現し，上部消化管検査にて胃噴門部小彎にⅡa型高分化腺癌を認めた，さらに小腸X線検査でTreitz靱帯から約20cmの上部空腸に結節状隆起を伴う多数の憩室陰影を認めた．push式小腸内視鏡を施行し，内視鏡所見および生検にて空腸癌と診断し，胃全摘術と空腸部分切除術を施行した．病理学的に空腸病変は2個の真性憩室内とその周囲に拡がる隆起型の高分化から中分化腺癌で，憩室内で漿膜下層に浸潤していた．

　A 77-year-old man was admitted to our hospital because of epigastric pain and anorexia. Barium-meal study and gastroscopy revealed IIa type cancer in the gastric cardia. Double-contrast radiography of the small intestine revealed an irregular and nodular tumor within and around the diverticula in the upper jejunum. Biopsy specimens taken from the tumor under push-type jejunoscopy contained an adenocarcinoma. The patient underwent total gastrectomy and partial resection of the jejunum. Histologic examination of the resected jejunum showed a well to moderately differentiated adenocarcinoma associated with the jejunal diverticula. The jejunal cancer had invaded the subserosa at the base of the diverticula.