回盲部腫瘤を呈した急性憩室炎（粘膜下層内）の1例

Acute Submucosal Diverticulitis Presenting as an Ileocecal Mass, Report of a Case

要旨　患者は47歳，男性．下血にて緊急大腸内視鏡検査を施行し，回盲部腫瘤からの出血を認め，入院2日目には自然止血した．注腸造影検査では，回盲部虫垂開口部位に陰影欠損像が認められ，中心部にバリウムが入り込む像がみられ，比較的典型的な憩室炎像であった．しかしその後も右下腹部の鈍痛が持続し，大腸内視鏡検査でも白苔を伴う表面平滑で発赤した平坦な隆起性病変が認められ，悪性疾患も完全に否定しきれないことから回腸右半結腸切除術を施行した．切除材料にて粘膜下層内にとどまる憩室炎と診断した．隆起性病変を呈した粘膜下層内憩室炎は非常にまれであり，粘膜下侵入腺との鑑別や緊急大腸内視鏡検査の意義について考察を加え報告した．

　A 47-year-old male underwent urgent total colonoscopy (Fig. 1a) because of bloody stool. An ileocecal mass was found to be the source of bleeding, which stopped spontaneously on the second hospital day. A contrast enema (Fig. 2) showed a filling defect in the appendiceal opening at the cecum with barium flowing into the central portion, which is characteristic of the diverticulitis. However, dull pain persisted in the right lower abdomen thereafter, and colonoscopy (Fig. 1b-d) revealed a smooth protuberant red lesion with white coating. Because malignancy could not be ruled out, right hemiileocolectomy was performed. Examination of the resected specimen revealed diverticulitis limited to the submucosa. We here report this rare case of submucosal diverticulitis presenting as a protuberant lesion as well as discussion on differentiation from the submucosal glands and the usefulness of emergency colonoscopy.