腸重積を起こした横行結腸脂肪腫に直腸癌を合併した1治験例

A Case of Submucous Lipoma of the Colon Associated with Acute Intussusception, and Complicated Cancer of the Rectum

　消化管の脂肪腫は比較的稀な疾患であり，文献上散見されるにすぎない．部位別にみると，本邦では胃の報告が多く，大腸脂肪腫の報告は比較的少ない．しかし近年，大腸脂肪腫の報告は漸次増加しており^1)～3)，今後も大腸診断技術の向上に伴って増加するものと思われる．最近われわれは腸重積を起こした横行結腸脂肪腫の術後，直腸癌を発見し，根治手術を施行した症例を経験したので報告する．

症例

　患　者：69歳　女性　無職

　主　訴：腹痛

　既往歴：62歳のとき乳癌にて手術および術後照射を受けた．乳癌はStage Ⅰであった．

　家族歴：特記すべきことなし．

　現病歴：1975年10月11日朝より臍周囲の強い腹痛があり，嘔吐した．近医を受診し，腹部単純X線検査を受けたが，特に所見なく鎮痛剤注射を受け帰宅した．しかし腹痛は2，3時間毎に発来し，軽快しないため10月13日同医院入院，10月14日当科へ転院した．排便は10月11日までは毎日あり，以後停止した．10月11日より食事摂取せず水分のみ摂取していた．

　A 67-year-old female was admitted to our hospital with complaints of severe abdominal pain and no bowel movements for three days. She had a past history of the right radical mastectomy for breast cancer at the age of 62. Emergency operation, performed on the second hospital day, revealed an acute intussusception of the transeverse colon, which was surgically removed. There was no other lesion noticed in the abdominal cavity at that time. In the resected loop of the colon, measuring 49 cm in length, a pedunculated and superficially necrotic tumor measuring 7 by 5.5 by 4.5 cm was found which was compatible with the tip of the intussusceptum. The cut surface of the tumor was lobulated and diffusely hemorrhagic. Histological examination revealed a submucous adult lipoma of the colon. She passed uneventful postoperative course. Postoperative barium enema revealed no stricture at the anastomosis, but a small filling defect was discovered near the rectosigmoid junction. Anterior resection of the rectum was done. A polypoid tumor measuring 3.5 by 3 cm histologically showed well-differentiated adenocarcinoma tubulare focally infiltrating to the muscular layer without metastasis. After operation, she had good recovery with no troublesome episode.

　The lipoma of the gastrointestinal tract is an uncommon tumor. The sites of the lipomas in the order of frequency are large intestine, small intestine and stomach in previous reports of the United States. However, the reported cases of the gastric lipomas in Japan are more frequent than those of the large bowel. It seems likely that this fact may reflect the wide use of the upper gastrointestinal examination in this country.

　Some of the lipomas of the large intestine were found incidentally during the operation for carcinoma of the large intestine. But in our case, the lipoma associated with intussusception manifested severe signs and symptoms, and the cancer of the rectum was incidentally found by postoperative barium enema. A case like this has not been reported previously in the literature so far as we reviewed.