原発性空腸癌の1例

PRIMARY CARCINOMA OF THE JEJUNUM, A CASE REPORT

Ⅰ．はじめに

　小腸は一般に悪性腫瘍の発生頻度が非常に低い部位で，藤本¹⁾らによると，その発生頻度は外科入院患者総数の0.1％にすぎないといわれている．また悪性腫瘍のうち，癌の発生する頻度はさらに低く，空回腸の癌はきわめてまれな疾患である．本邦では西²⁾の空腸癌の報告以来，年々増加の傾向がある．

　最近，われわれは胃潰瘍および小腸狭窄のために手術を施行し，術後の組織検査によって原発性空腸癌と判明した1例を経験したので報告する．

　A relatively rare disease, primary carcinoma of the jejunum recently encountered is discribed in this paper with some comments on its literature.

　Case: a female 55 years of age.

　Chief complaints: pain and sensation of fullness in the abdomen.

　Past history: Since May 1966, she had been treated by her doctor on account of gastric ulcer.

　Present history: On March 29 1967, she was suddenly attacked by pain and extreme sensation of fullness of abdomen. As medical treatments were ineffective to alleviate her pain, she was examined at a medical office by x-ray. The diagnosis was gastric ulcer and intestinal stricture. The patient was then referred to authors’ hospital.

　X-ray findings: In double contrast study of the stomach, deformity of the incisura with mucosal convergence was noted. In the intestine a stricture was also found with its oral loop dilated. Operation was performed under the preoperative diagnosis of intestinal constriction and gastric ulcer scar.

　Findings at operation: In the serosa of the stricture, 170cm away from the Treitz's ligament, a scar-like white spot was observed. As several regional lymph nodes were swollen in neighboring mesentry, metastasis from gastric cancer was suspected. Thorough examination of the stomach revealed no cancer lesion. However, as it was impossible to rule out gastric cancer after all, partial gastrectomy including ulcer scar was performed next to the resection of the strictured intestinal segment.

　Histopathorogical picture: No gastric cancer was demonstrated. The stricture in the jejunum was caused by adenocarcinoma infiltrating into the subserosal layer.