小腸X線検査で術前に診断しえた出血性Meckel憩室の2例

Roentgenologic Demonstration of Bleeding Meckel's Diverticulum, Report of Two Cases

要旨　出血性Meckel憩室の術前診断は，^99mTc-pertechnetateシンチグラフィ（以下，^99mTcシンチ），小腸X線検査，血管造影でなされている．^99mTcシンチでpositiveであれば診断は確定するが，false negativeの場合はほかの検査で診断せざるをえない．ところで，術前に小腸X線検査で診断しえた報告例は少ない．今回われわれは，出血性Meckel憩室の2例を経験した（症例1：16歳，男性，症例2：12歳，女性）．^99mTcシンチでは，〔症例2〕はpositiveで術前に診断が確定したが，〔症例1〕ではnegativeであった．一方，小腸X線検査では2例ともMeckel憩室が描出され，診断に有用であった．若干の文献的考察を加え報告する．

　We presented two cases of bleeding Meckel's diverticulum. ^99mTc-scintigraphic results were negative in case 1 (16 year old, male), and positive in case 2 (12 year old, female). But in both cases, barium follow-through examination clearly demonstrated Meckel's diverticulum arising from the mid-ileum, and partial resection of the ileum including Meckel's diverticulum was performed. Macroscopically, Meckel's diverticula were 2.4×1.1×1.0 cm (case 1) and 3.0×2.0×2.0 cm (case 2) in size. No ulceration was detected in either case. Microscopically, ectopic gastric mucosa was found only in a small area of the most distal part of the Meckel's diverticulum in case 1, whereas it was found on the whole interior surface of the Meckel's diverticulum in case 2.

　We consider that barium follow-through examination is a useful method for preoperative diagnosis of Meckel's diverticulum, especially when ^99mTc-scintigraphy is negative in a suspicious case.