小腸内視鏡にて確認しえた空腸lipomatosisの1例

Lipomatosis of the Jejunum Diagnosed by Small Intestinal Endoscope, Report of a Case

要旨　患者は65歳の男性．1996年6月ころより時に腹痛があったが放置していた．1997年9月に腹痛とともに嘔吐が出現し，野元外科胃腸科医院を受診し腸閉塞と診断された．小腸X線検査で多発する隆起性病変を指摘され，同年9月12日当科紹介入院となった．当科の小腸X線検査では空腸40cmにわたり，数十個の大小不同な類円形の隆起性病変を認めた．内視鏡検査では，黄色調の粘膜下腫瘍が多発しており生検結果は脂肪腫であった．以上より空腸lipomatosisと診断した．小腸部分切除術を施行し，腸間膜付着対側を中心に約130個の脂肪腫を認めた．本症例の診断には小腸内視鏡検査が有用であった．

　A 65-year-old man was admitted with the complaint of abdominal pain and vomitting. He was diagnosed by a plain abdominal x-ray film as having abdominal obstruction. X-ray examination of the small intestine showed numerous oval-shaped elevated lesions of various sizes as long as 40 cm diffusely distributed in the jejunum. A push-type small intestinal endoscope demonstrated numerous submucosal tumors in the jejunum. The surface of the tumor was smooth and looked yellowish. Histological examination of the biopsy specimens disclosed lipoma composed of mature adipose tissue. Based on these finding, this case was diagnosed as lipomatosis of the jejunum. Partial resection of the jejunum was performed. The resected specimen showed approximately 130 lipomas on the antimesenteric site of the lumen. Small intestinal endoscopy was very effective in this case for the determination of the diagnosis.