大きな十二指腸乳頭部腺腫を合併した大腸腺腫症の1例

Adenomatosis Coli Associated with Large Adenomas of the Major and Minor Papillae

要旨　症例は37歳の男性で，1974年9月に家族性大腸腺腫症の診断にて結腸全摘術を受けた．大腸の腺腫は密生型で，進行癌はなかった．その後，年に数回の頻度で残存直腸のポリープ摘除を目的として外来通院していた．初回入院時，1976年5月，1977年3月，1979年4月の計4回にわたって上部消化管X線検査を施行したが，胃・十二指腸にポリープを認めなかった．1983年4月に無症状であったが，定期検査として上部消化管内視鏡検査を行ったところ，十二指腸乳頭および副乳頭の腫大を認め，生検にて腺腫と診断されたため，経十二指腸的に腫瘤切除を施行した．乳頭はO.8×1.6cm，副乳頭は0.8×1.4cmの腺腫で，悪性所見はなかった．大腸腺腫症患者の上部消化管にはポリープが高頻度に合併し，また，胃癌，十二指腸傍乳頭部癌も多数報告されていることから，大腸腺腫症患者のfollow-upの際，定期的に上部消化管を検索することが大切である．

　A 28 year-old man with complaint of rectal bleeding was found to have familial adenomatosis coli and received total colectomy with ileorectal anastomosis in September 1974. Histologic examination disclosed numerous tiny adenomas throughout the Iarge bowel without advanced carcinoma. He was followed up with colonoscopy and polypectomy of the preserved rectum several times a year. Three times of barium meal examination of upper gastrointestinal tract showed no polyps of the stomach and duodenum. In April 1983 gastroduodenoscopy, which was performed for the first time, revealed the enlarged major and minor papillae and several tiny polyps of the duodenum, without any polyps in the stomach. He was asymptomatic and clinical laboratory examinations showed no abnormal values. Local excision of tumors was performed through duodenotomy. Histologically, both tumors of the major and minor papillae were adenomas without any malignant change.

　Until recently, surveillance of patients with adenomatosis coli who had received prophylactic colectomy has been restricted to examination of the rectum. However, recent studies disclosed the frequent presence of polyps in the stomach and duodenum in patients with adenomatosis coli, and 35 cases of periampullary carcinoma associated with adenomatosis coli were reported in the world literature. It is necessary to perform periodic upper gastrointestinal endoscopy in following up of polyposis patients in order to detect malignancy of the stomach and duodenum in its early stage.