内視鏡的に切除しえたIntraluminal Duodenal Diverticulumの1例

Intraluminal Duodenal Diverticulum Treated by Endoscopic Electrosurgery, Report of a Case

　消化管の稀な先天性奇形の1つであるIntraluminal Duodenal Diverticulumは，現在までに外国では78例，本邦では8例の報告があり，その治療としては，約2/3の症例で外科的憩室切除術が行われている．最近，われわれは本邦第9例目を経験し，内視鏡的憩室切除術を施行したが，現在までに本症に対するこのような治療法の報告はなく，第1例目と考えられるので，ここに報告する．

　Intraluminal duodenal diverticulum, a rare anomaly of gasrtointestinal tract, has been reported more frequently since the communications of Schmidt (1941), Nelson (1947) and Kinzer (1949). As far as we know, 86 cases of this disease have been reported throughout the world, including 8 cases in Japan. But concerning the therapy, about the two-thirds of them were operated on and the rest were given only palliative treatment. This is the first report of intraluminal duodenal diverticulurn treated by endoscopic electrosurgery.

　This 23-year-old female patient was admitted to our hospital with the chief complaint of epigastric pain after eating. The onset of present illness was noted in the middle of July, 1978. She was, therefore, admitted for treatment. Past and family history was negative. Physical examination revealed only epigastric tenderness with resistence. All the indicated laboratory studies were within normal limits. Upper gastrointestinal series demonstrated the typical appearance of barium-filled sack-like structure with surrounding thin translucent zone in the descending part of the duodenum. Duodenal fiberscope showed an intraluminal duodenal diverticulum in the descending part of the duodenum with no other abnormality. ERCP showed normal pancreatic duct and biliary tract systems.

　Endoscopic electrosurgery was applied with polypectomy-snare on October 11, 1978. The postoperative course was uneventful except mild hemorrhage from the incision part. She was discharged symptomfree about a month after resection of the diverticulum. The histological appearance of the diverticulum was that of normal duodenal mucosa lining both sides of the sack except fecal inflammation. The muscularis mucosae was seen between them.