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Stomach and Intestine(Tokyo) Volume 21, Issue 3 （March 1986）

胃と腸 21巻3号（1986年3月発行）

Japanese English

症例

腸閉塞症状を繰り返した小腸脂肪腫の1例 Intestinal Lipoma of the Jejunum, Report of a Case 種ケ島和洋 ¹ , 鈴木紘一 ¹ , 斉藤昭 ¹ , 河上裕 ¹ , 小尾和洋 ¹ , 北洞哲治 ¹ , 金井歳雄 ² , 篠原央 ² , 宇都宮利善 ² , 向井美和子 ³ Kazuhiro Tanegashima ¹ , Koichi Suzuki ¹ , Shou Sairo ¹ , Hiroshi Kawakami ¹ , Toshio Kanai ² , Miwako Mukai ³ ¹国立大蔵病院消化器科（現　濁協医科大学医学部放射線科） ²国立大蔵病院外科 ³国立大蔵病院病理 ¹Department of Internal Medicine, National Ohkura Hospital ²Department of Surgery, National Ohkura Hospital ³Department of Pathology, National Ohkura Hospiral pp.303-307

発行日 1986年3月25日 Published Date 1986/3/25

DOI https://doi.org/10.11477/mf.1403110161

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Abstract 文献概要
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要旨　患者は59歳，女性．発作性の腹痛・嘔吐を繰り返し，1年前に胆石症の診断のもとに胆嚢摘出術を受けたが症状は変わらず，同症状にて当院外来受診時の腹部単純X線像でわずかなニボー像を認めたため入院となった．臨床所見では軽度の右側腹部圧痛と貧血を認め，便潜血（＋）以外には検査成績に異常はなかった．腹痛は翌日軽快し，小腸ニボー像も消失．小腸造影にて空腸中部に表面平滑な長径17mmの腫瘤が明らかにされた．手術所見ではTreitz靱帯より約100cmの空腸に重積した腸管を認め，約25cmを切除．同部の腸管は漿膜側に及ぶ線維性肥厚がみられ，繰り返し重積が生じていたと思われた．その腸管膜付着側に表面平滑な3.0×2.0×1.5cmの山田IV型ポリープを認め，組織学的に脂肪腫と診断した．1980～1982年における本邦の集計では，脂肪腫は27例と，小腸良性腫瘍中26％を占め，男女差は認めず発症は30～80歳台に広く分布している．大きさは10cm以下が95％で，部位はTreitz靱帯とBauhin弁から各々60cm以内の小腸に82％が存在し，小腸狭窄，閉塞症状により発見された症例が66％を占めた．有症状時の腹部単純X線写真が手掛かりとなって，術前に病巣の存在診断が可能であった小腸脂肪腫の1例を報告し，本邦における文献的考察を加え小腸良性腫瘍の問題点につき言及した．

　A 59-year-old woman with frequent complaints of abdominal pain and vomiting, underwent cholecystectomy following a diagnosis of allstone. Even after the operation, her symptoms were not relieved for seven months, and had been treated as postcholecystectomy syndrome.

　She was referred to our hospital with the same complaints. Her plain abdominal x-ray films revealed a little amount of niveau-like appearance in the small intestine. Laboratory findings showed mild anemia and faintly positive blood reaction in the stool. In a double contrast study of the intestine, a tumorous shadow, smooth-surfaced with bridging folds, 17mm in size, was found in the mid-portion of the jejunum. On operation, accompanying invagination was found at the distance of 100cm from the Treitz's ligament. Histological specimen of the resected jejunum demonstrated a 3.0×2.0×1.5cm, smooth-surfaced polypoid (Yamada IV type) tumor which was disclosed finally as lipoma. Twenty seven cases of intestinal lipoma were reported during 1980 to 1982 in Japan. The symptoms of small intestinal lipoma showed oftenly intestinal obstruction as compared with bleeding from leiomyoma or hemaogioma. Thus a rare case of lipoma of the jejunum is reported, which was suspected with plain abdominal x-ray films showing subileus due to intussusception, and then diagnosed as such before operation solely with double contrast x-ray study.