消化管出血を来し術前部位診断ができた小腸血管腫の1例

Hemangioma of the Small Intestine, Report of a Case

要旨　患者は53歳の男性で，下血を主訴に紹介入院となった．大腸内視鏡検査で，Bauhin弁から約1cmの回腸に，出血を伴う約1cm大の粘膜下腫瘍を認めた．選択的上腸間膜動脈造影で回結腸動脈に綿花状のpooling像を認め，血管腫を疑った．回盲部切除術を施行した．切除標本では，回腸に0.5×0.5cmの小隆起性病変を認め，その表面には凝血塊が付着していた．病理組織学的には粘膜下層に血管腫があり，粘膜が欠損して腫瘍が回腸内腔に露出していた．腫瘍の上部は単純性毛細血管腫を，下部は多発性静脈拡張症を呈する，2つの成分により構成された血管腫と診断した．本邦報告例69例中，術前診断しえたのは5例で，術前診断には選択的上腸間膜動脈造影が有用であった．

　A 53-year-old man was referred to our hospital with a complaint of melena. Colonoscopic examination showed a submucosal tumor in the ileum at a distance of 1 cm from the Bauhin's valve. Superior mesenteric angiography showed a pooling of contrast medium in a branch of the ileocecal artery. Ileocecal resection was performed. Histological examination of the resected specimen showed a hemangioma which consisted of simple capillary hemangioma and multiple phlebectasia. Only five out of 69 reported cases in Japan were diagnosed preoperatively. Selective angiography is useful for preoperative differential diagnosis of hemorrhage of the small intestine.