卵巣子宮内膜症術後に発症した腸管子宮内膜症の1例

Endometriosis of the Rectum, Report of a Case

要旨　患者は，38歳，女性．36歳時，当院婦人科で左卵巣子宮内膜症のため子宮付属器切除術施行．術後1年後から，月経周期に一致する下血を主訴として当科紹介．注腸造影検査では，直腸Rs部前壁側からの片側性圧排像とtransverse ridgingを認めた．大腸内視鏡検査では，直腸S状部の粘膜面に一部発赤を伴った管腔の1/2周を占める粘膜下腫瘍様隆起と伸展不良を認めた．画像所見から腸管子宮内膜症を考え，6か月間ホルモン療法を施行し症状は改善した．

　A 38-year-old woman with the chief complaints of melena and lower abdominal pain was refferred to the Cancer Institute Hospital. The pain continued during the menstruation period which had started about one year before. She was underwent left adnexectomy about two years before, and the resected specimen revealed endometriosis. Barium enema study showed a relatively narrow segment of rectosigmoid colon, with nodular elevations and converging folds. Endoscopic examination showed a slight reddish mucosal elevation mimicking a submucosal tumor. Although biopsy specimens were negative, she was diagnosed with endometriosis according to her past medical history and the image findings of barium enema study and endoscopic examination. Hormonal therapy controlled her symptoms well. Medical history of the patient seems to be important for diagnosis as the imaging.