2か所に腫瘤を形成した腸管子宮内膜症の1例

Intestinal Endometriosis with Two Lesions, Report of a Case

要旨　無症状の31歳，女性の直腸とS状結腸の2か所に粘膜下腫瘍様所見を呈した腸管子宮内膜症を経験した．注腸X線，内視鏡検査に加えて，超音波内視鏡，MRIなどの所見を合わせて術前診断することによって，病変の局在を明確にするとともに，本症の確定診断を下すことができた．本症は腸管内に多発することも少なからずある．本症は病悩期間も長く診断困難例も少なくないため，取り残しのないよう，多発病変を看過しないように努めるべきである．

　Two submucosal tumors were detected in the rectum and sigmoid colon in a 31-year-old woman with no complaints and symptoms. Barium enema study disclosed a narrow segment with thickened folds in the sigmoid colon and a submucosal tumor in the rectum. Colonoscopy showed a submucosal tumor with a smooth surface and vascular ectasia. EUS and MRI were useful to detect the location of the tumor; low intensity and/or echoic pattern suggested endometriosis.

　Multiple lesions sometimes arise in the lower colon as shown in this case report. If both of the two lesions had not been detected and remained during surgical operation, patient's complaints of severe crampy abdominal pain would have continued. Therefore, several kinds of image analyzing techniques should be necessary for preoperative diagnosis.