十二指腸潰瘍治療中に発見された回腸脂肪腫の1例

Ileal Lipoma with Recurrent Duodenal Ulcer, Report of a Case

要旨　消化器の脂肪腫は比較的まれな疾患で，一般に特異的症状を欠くため，腸重積症や出血により偶然発見されることが多く，術前に診断されることは極めてまれである．最近われわれは，41歳，男性で再発を反復する十二指腸潰瘍で，潰瘍消失後も腹部に不定愁訴を残したため注腸造影を行い，回腸終末部に生じた脂肪腫を発見し，胃切除術と共にその部を切除し治癒させた症例を経験したので報告した．本例の脂肪腫は治療の対象とした原疾患と非常にかけ離れた部位にあり，このような症例は文献上あまり類をみないようである．

　A man aged 41was admitted to our hospital with a major complaint of epigastralgia. He had duodenal ulcer for four years for which he was hospitalized three times. Although the duodenal ulcer healed by conservative treatment only, abdominal nonspecific symptoms persisted. An irrigography showed a filling defect of the contrast medium at the terminal ileum. Small intestinal radiography revealed an oval tumor with a smooth contour. Under the diagnosis of a lipoma or benign polyp of the terminal ileum and a recurrent duodenal ulcer, an ileocecal resection and a partial gastrectomy were performed. The resected specimen showed a polypoid tumor, 15×10×10mm in size, 3cm oral to the ileocecal valve. Incidentally a diverticulum of the cecum was found. Histological examination showed that the tumor was composed of mature adipose tissue in the submucosa. A definite diagnosis as a benign lipoma of the terminal ileum was made.

　This lipoma was found during treatment of a primary gastrointestinal disease, and the distance between the lipoma and the lesion of the primary disease was more distant in this case than in the prevlously reported six cases that we are aware of in Japan.