腸捻転を来した多発性憩室合併の小腸多発性脂肪腫の1例

Multiple Lipomas of the Ileum with Multiple Diverticula Causing Volvulus, Report of a Case

要旨　患者は58歳，女性．腹痛を主訴に他医受診．腹部X線検査で腸閉塞と診断された．保存的治療を受け軽快したが，精査のため当科に紹介となった．小腸造影検査で回腸の一部に大小不同の透亮像と憩室が多数認められ，同部は捻転していた．腹部CT検査で回腸に低吸収値を示す腫瘍が充満しており，多発性脂肪腫と診断した．また，回腸の捻転像も認められた．開腹すると脂肪腫が多発した長さ1mの回腸は捻転していた．同部を切除した．切除標本では多発する脂肪腫の間に憩室が多発していた．腸捻転，多発性憩室と小腸多発性脂肪腫の因果関係について文献的に考察した．

　A 58-year-old woman was admitted with the complaint of abdominal pain and vomiting. Abdominal x-ray films revealed ileus, but it improved without operation. Radiographic studies of the small bowel showed numerous round filling defects and diverticula. Barium enema studies showed coiled stricture of the terminal ileum. CT scan revealed multiple low density areas in the ileum and volvulus of the ileum. We diagnosed her illness as multiple lipomas of terminal ileum. As for the operative findings, numerous soft movable masses were palpated in the 100 cm long segment of the ileum. This segment was markedly dilated and its mesenterium was twisted. The affected segment of the ileum was resected. Pathological examination yieled a diagnosis of multiple lipomas and diverticula of the ileum.