大量下血を来した8mmの空腸脂肪腫の1例

Jejunal Small Lipoma with Melena, Report of a Case

要旨　患者は62歳，女性．主訴はタール便．著しい貧血と低蛋白血症があった．小腸造影でTreitz靱帯から180cmの空腸に，中央に凹凸不整な浅い陥凹を伴った径8mmの山田Ⅲ型の隆起性病変を認めたが，質的診断は困難であった．術中内視鏡検査ではbridging foldを伴った表面平滑，立ち上がりの緩やかな黄色調の粘膜下腫瘍が観察され，脂肪腫が疑われた．切除標本上，病変は直径8×7mm，高さ6mm，中央に5×6mmの発赤の強い浅い潰瘍を伴い，組織学的に脂肪腫と診断され，本邦報告例では最小の単発例と考えられた．また，1980年から1989年までの10年間の本邦報告例についても集計し，考察を試みた．

　A 62-year-old woman was admitted to our hospital complaining of tarry stool. Intestinal barium x-ray revealed a small polypoid lesion with a shallow ulceration in the jejunum. Intra-operative endoscopic examination demonstrated a smooth-surfaced yellowish submucosal tumor with bridging folds.

　On operation, the tumor was observed in the jejunum at a distance of 180 cm from Treitz's ligament. Histological specimen of the resected jejunum demonstrated an 8×7×6 mm, smooth-surfaced polypoid tumor associated with a 5×6 mm ulceration which was diagnosed finally as a lipoma. We consider that this is the smallest single lipoma of the small intestine among the reported cases in Japan.