原発性回腸癌の1例

A Case of Primary Cancer of the Ileum

　胃や大腸の癌が多いのに反して小腸癌が非常に少ないことは興味があるが，これは東西に共通している．Paulson¹⁾によると胃腸癌のうち小腸癌は僅か1％という．一方わが国では癌研における1946年より1968年までの23年間の手術において²⁾，十二指腸，空腸，回腸10例，結腸，直腸820例，胃癌4,514例であり，小腸癌は0.2％弱にすぎない．

　倉金³⁾らによるとわが国における小腸癌（空，回腸）の報告例数は1912年西の報告以来155例にすぎない．また術前診断は困難であり，臨床的およびX線的に狭窄症状によって行われており，本邦症例中腸狭窄或は腸閉塞と診断され，開腹手術により癌が発見された場合が最も多いという．

　The patient is a 63-year-old housewife, who had ambulatory treatment of lung tuberculosis for one year and a half in 1955 She visited our hospital on January 4, 1971 because since October of the previous year she had felt such symptoms as sitting heavy on the stomach after meals and griping pain in the abdomen. Palpebral conjunctivae were anemic, and the occult blood in the stool was strongly positive. RBC 3,050,000 and Hb 7.9/dl. Blood sedimentation rate for one hour was 20 mm Liver function tests were all within normal limits, nor was there any abnormality to be recognized not only in the x-ray pictures of the esophagus, stomach, duodenum, colon and gallbladder, but also in endoscopy of the stomach. On February 19 she was admitted to the hospital for further check-up. As colonofiberscope also yielded nothing unusual, we suspected bleeding from the small intestine. After swallowing 100 gr barium meal, the patient was examined hour by hour under x-ray TV with compression applied to the bowel. The cecum was seen to form a conglomerate, suggesting something was wrong there. When she was re-examined four days later, we have tried to dissolve the conglomerate by lowering the head with various degrees of compression applied. By so doing, we were able to detect a constricted segment about 3 cm long with hard and irregular margins. The patient underwent surgical correction on March 5 under a tentative diagnosis of cancer of the ileum. A hard tumor was palpated 90 cm oral from the ileocecal valve. White ring-like constriction was caused by it. Cancer infiltion was seen in the mesentery with a dozen of lymph nodes palpable there. The ileum was resected from 20 cm oral from the ileocecal valve to 130 cm oral to it, followed by end-to-end anastomosis. No tumor was palpated in the abdominal organs The mucosal surface of the resected intestine showed irregular elevations and depressions, with the segment oral from the cancer lesion dilated twice as much as that distal from the lesion. Histopathologically, it was tubular adenocarcinoma, invading already the serosal surface with involvement of lymph nodes in the mesentery.