子宮内避妊具と注腸所見よりほぼ確診を得た骨盤放線菌症の1例

Pelvic Actinomycosis Confirmed from IUD History and Barium Enema Findings, Report of a Case

要旨　患者は57歳，女性．卵巣腫瘍の疑いで当院産婦人科で開腹したが，骨盤内に卵巣，S状結腸，間膜などが一塊となる易出血性の巨大腫瘤を認め，根治手術が危ぶまれた．腫瘤表面の術中迅速組織に悪性所見を認めなかったことから，いったん閉腹し当科に診断の依頼がなされた．問診にて患者の子宮内避妊具長期留置歴を聴取，注腸検査のS状結腸広域のほぼ全周性狭窄と腸管辺縁鋸歯状陰影所見より，骨盤放線菌症の腸管浸潤病変を疑った。自験例では，病理組織学的な放線菌塊の証明はなされなかったが，CT，MRI所見も検討して各種類似疾患を除外し，penicillin療法の著効した臨床的推移と併せ，骨盤放線菌症と診断した．

　A 57-year-old woman underwent surgery for a suspected ovarian tumor. There was a large mass, which included the ovary, sigmoid colon, and mesentery, and which bled easily. However, intraoperative histological examination of a needle biopsy specimen showed no evidence of malignancy, so the operation was suspended.

　Barium enema showed a long, circumferential stenosis of the sigmoid colon with a sawtooth margin. The patient had used an IUD previously. From these findings, we suspected that the large mass was caused by pelvic actinomycosis. The diagnosis was confirmed by CT and MRI findings and by the fact that penicillin was very effective, although drusen was not demonstrated on histological examination.