隆起性空腸癌の1例

A Protruding Type Carcinoma of the Jejunum

　小腸，殊に空・回腸の癌は比較的まれな疾患であり，診断は困難な場合が多い．最近われわれは原因不明の貧血で6カ月間保存的療法を行った患者で小腸X線検査で空腸に隆起性の癌を認めた1例を経験したので報告する．

　A50-year-old woman had episodes of reccurrent gastrointestinal bleeding and left upper abdominal pain for six months. Repeated upper gastrointestinal series and barium enema showed no abnormality. A barium follow-through examination of the small intestine disclosed a protrusion with multiple erosions suggestive of cancer in the jejunum 20cm distal to the ligament of Treitz, which was more precisely delineated by a compression study. On September 20, 1976, she suddenly had severe abdominal pain accompanied by nausea and vomiting. An emergency operation was performed under a diagnosis of ileus. On laparotomy, an acute state of intussusception of the jejunum was found and the involved intestine was removed. On pathological examination, a tumor measuring 6×5cm in diameter was found. Macroscopically, it resembled Borrmann I type of gastric cancer. It was considered that the tumor had been the intussusception. Histological examination revealed a well differentiated adenocarcinoma tubulare infiltrating down to the subserosa. Metastasis neither to the regional lymph nodes nor to the other organs was detected. On October 24, 1977, she underwent another operation due to carcinoma of the sigmoid colon. Now four and half years after the first operation, she is well without any signs of reccurrence.