Meckel憩室に発生したカルチノイドの1例

A Case of Meckel's Diverticulum associated with Carcinoid Tumor

　Meckel憩室は多彩な合併症を伴う奇形であるが，なかでもカルチノイドの合併は極めて稀であり，本邦における報告例は見当らない．著者らは下血と汎発性腹膜炎を呈した19歳男子を手術し，Meckel憩室穿孔を確認し，その後，病理組織学的検索により，偶然，カルチノイドの合併を認めたので，若干の考察を加えて報告する．

症例

　患　者：19歳男子学生

　主　訴：右下腹部痛．

　現病歴：本院入院の半年前，下腹部痛および下血をきたし，約1週間入院4カ月後，再び下血をきたしたが，原因不明のまま放置．入院1週間前より，下腹部痛が続き，急に激痛となり，昭和48年10月8日来院．

　初診時，下腹部全般に著明なBlumberg徴候およびデファンスを認め，圧痛は右下腹部に強かった．眼瞼結膜は貧血性で，Ht29％，Hb8．敬/dl，WBC19,900であった．

　穿孔性虫垂炎の診断のもとに直ちに開腹．腹腔内には混濁した滲出液を多量に認め，穿孔性腹膜炎を思わせた．虫垂は浮腫状を呈するのみで穿孔を認めず，回盲弁より40cmの回腸に，穿孔を伴ったMeckel憩室を見出した（Fig. 1）．これを回腸部分切除を加えて摘出し，回腸端々吻合を施して手術完了．

　The authors performed on operation on a 19-year-old male with peritonitis due to perforation of Meckel's diverticulum, and incidentally found a smali carcinoid tumor located in it. Gastric and small intestinal mucosae were present in Meckel's diverticulum. Perforation was caused by a peptic ulcer located in the region of small intestinal mucosa. The carcinoid tumor was located in the submucosa to the muscularis of the small intestinal mucosal region, and measured 1 mm in diameter. The tumor was benign histopathologically. The patient showed no evidence of carcinoid syndrome.

　Carcinoid of Meckel's diverticulum is very unusual. To date, only 40 cases have been reported in world literature. There are no reported cases in Japan. The present case is presumably the first reported case in Japan.