回腸末端部原発の細網肉腫による慢性腸重積症の1例

A Case Report of Chronic Intussusception of Ileo-cecal Region, induced by Malignant Lymphoma

症　例

　患　者：44歳　主婦

　主　訴：腹部膨満感および腹痛

　既応歴：若い頃，胸膜炎．15歳頃よりケロイド体質といわれ，某医科大学で治療をうけたことがある．

　現病歴：1973年12月中旬，右下腹部痛があり某外科医を訪れ，急性虫垂炎の診断のもとに12月17日，虫垂切除術を受け，23日退院した．退院後4日ほどしてから虫垂切除術術創瘢痕のやや上方で臍の右側が痛むようになり，同外科医の診察をうけたが異常はないといわれた．しかし腹痛は持続するので，別の外科医を訪れたところ，癒着のためかもしれないから精査するようすすめられ，1974年1月23日，本院を受診した．内科外来受診時の現症では，臍の右側に小手拳大の弾力性のある腫瘤を触知し，やや可動性を認めた．また腸のグル音はやや亢進していた．腸腫瘍ないし腸閉塞を疑ってただちに腹部単純X線写真を撮ったが腸閉塞を疑わせるガス像はなく，臨床症状でも腸閉塞を思わす症状に乏しかった．患者は元来便秘がちであるが，右下腹部痛が始まって以来ことに便秘が強く，4～7日に一度下痢様の柔らかい便が出る程度であった．食欲はあり，腹痛は食事とは無関係であった．腹痛は腹部膨満感から始まり，次第に右下腹部より膀の右側に拡がり，しばらくしてからゴロゴロと腹鳴を伴って腸が動くような感じがして腹痛は楽になるということであった．

　A 44-year-old woman was admitted to our hospital with chief complaints of abdominal fullness and right lower abdominal pain. She had been troubled with abdominal pain of the right lower quadrant during one month before the admission, and appendectomy had been performed at a hospital. However, there was no remission.

　On admission, a mobile, fist-sized tumor was palpated in the right lower abdominal quadrant. X-ray examination by barium enema of the colon revealed a large filling defect projecting into the barium-filled colon. Ileocecotomy was performed under a diagnosis of intussusception of the transverse colon. Surgical material showed that the tumor was 8.0×5.0×2.5 cm in size and localized on the Bauhin's valve, involving the terminal ileum as well as the cecum partially. No metastasis in mesenteric lymph nodes was seen. Histological diagnosis was reticulum cell sarcoma, arisen from the terminal ileum. The number of reported cases of Japanese adult intussusception in the recent 9 years (1964～1972) were 86. Among them secondary intussusception was seen in 74 cases (86％) and the ileocecal portion was the site most commonly involved (47 cases) and in 18 cases of them, malignant lymphoma was revealed as the cause of it.