S状結腸間膜脂肪織炎の1例

Sigmoid Colon Mesenteric Panniculitis, Report of a Case

要旨　患者は56歳，女性．下腹部痛で来院し，左下腹部に手拳大の腫瘤を触知した．注腸X線検査ではS状結腸は狭窄し浮腫状に腫大したひだがみられ，その辺縁は腸間膜側で不整鋸歯状であった。大腸内視鏡検査ではS状結腸は狭窄していたが，送気により膨らんだ．粘膜面には浮腫状に腫大したひだがみられた．CTではS状結腸間膜は肥厚し腫瘤を形成し，左水腎症も認められた．以上からS状結腸間膜脂肪織炎が強く疑われた。開腹するとS状結腸間膜は黄白色に肥厚していた．開腹生検標本には膠原線維の増生，炎症細胞の浸潤，泡沫細胞がみられ上記診断は確定した．術後半年後のX線・内視鏡検査ではS状結腸はほぼ正常になっていた．

　A case of sigmoid colon mesenteric panniculitisseen in a 56-year-old woman is reported. The patient complained of lower abdominal pain of ten days' duration.

　Physical examination revealed a tender and hard fistsized mass in her left iliac region. The laboratory findings on admission were normal except for positive CRP and increased ESR.

　Barium enema study demonstrated narrowing of the sigmoid colon and saw-tooth-like appearance at its mesenteric side. Colonoscopic examination showed narrowing and edema of the sigmoid colon. The CT scan revealed a large mass with increased attenuation in the sigmoid colon mesentery.

　Exploratory laparotomy revealed thick yellow sigmoid colon mesentery. Pathological examination of the biopsy yielded a diagnosis of mesenteric panniculitis.

　We discussed 28 cases reported in Japan of the sigmoid colon mesenteric panniculitis including our case. In future, laparoscopy should be used to diagnose this disease so as to avoid unnecessary operations.