Meckel憩室内翻症の1例

Inversion of Meckel's Diverticulum, Report of a Case

要旨　患者は間歇的右下腹部痛と貧血を主訴に入院した30歳男性．消化管造影検査，内視鏡検査を行い，小腸X線検査で回腸下部に可動性のペニス様腫瘤病変を認めた．腫瘤先端は浅いくびれを有し，茎は辺縁平滑であったが経大腸的小腸X線検査ではKerckring皺襞様のひだを有し小腸粘膜への移行が認められた．以上の所見より小腸良性腫瘍を疑い開腹手術を施行し内翻したMeckel憩室が先進部となった回腸‐回腸型の腸重積を認めた．同部を含め小腸を約10cm切除した．腫瘤先端は潰瘍を形成し，一部に幽門腺様粘膜を認めた．小腸X線検査で特徴的所見を描出すれば内翻Meckel憩室の術前診断は可能であると考えられる．

　A 30-year-old man was admitted to our hospital in January, 1983, complaining of intermittent abdominal pain and anemia. Physical examination revealed tenderness of the lower abdomen. Laboratory studies showed anemia, and blood in the stool. Radiological examination of the small intestine demonstrated an abnormal penis-like appearance with folds on its stalk in the distal ileum. Laparotomy was carried out following a tentative diagnosis of benign tumor of the ileum. Intussusception of the ileo-ileal type was evident 100 cm orally from Bauhin's valve, and it unraveled easily. A soft tumor was palpable at the apex of the intussusception. Partial resection of the ileum with end-to-end anastomosis was performed. A penis-like polyp that developed from the opposite site of the mesenterium was about 7 cm in length with ulceration on the top. Histological section revealed that the polyp was the Meckel's diverticulum. It consisted of the entire layer of the small intestine with pseudopyloric glands around the ulceration.

　The characteristic appearance of the inverted Meckel's diverticulum in radiological examination of the small intestine was demonstrated. This is the key for diagnosis prior to laparotomy.