S状結腸にみられた若年性ポリープ（Juvenile polyp）の1治験例

Experience with a Case of Juvenile Polyp of the Sigmoid

　最近，直腸，結腸などに対するレ線的，内視鏡的診断技術の進歩によって，外科医が取り扱う大腸疾患は増加している．小児における大腸疾患は成人に比べて少ないが，十分留意すれば，今後かなりの症例に遭遇する可能性があると考えられる．

　1847年Guersantが“小児の肛門より脱出する直腸ポリープ”を報告して以来，直腸，結腸の若年性ポリープは，諸外国において，現在までかなり報告されているが，本邦では，1973年までに40例が報告されたに過ぎず，比較的稀な疾患といえる．これはMorsonの分類による過誤腫性ポリープ（hamartomatous polyp）で，悪性変化は少ないとされている．われわれは，最近，この1例を経験し治癒せしめたので，その概略を紹介するとともに，若干の文献的考察を加えたい．

　The recent immense progress in the diagnostic techniques of roentgenography and endoscopy has made it practicable to detect minute lesions even in the rectum or colon as well as in the stomach and duodenum. Cases of intestinal polyps found thereby are increasing. A case of juvenile polyp of the sigmoid has recently been experienced at this hospital, in a girl baby 1 year and 9 months of age who was first examined because of blood in the feces. Peranal digital palpation revealed a mass in the lower bowel which was later found to be an ovoid, dark-red polyp on rectoscopic examination. The mass was resected by peranal operation and was histologically confirmed as juvenile polyp.

　Juvenile polyp of the colon and rectum has been described to occur with an incidence from 0.1 to 5.1％ and to be characterized grossly by a single, round, smooth-surfaced, elastically soft, pedunculated benign growth and microscopically by the mucous glands showing numerous various-sized cystic formations covered with muciparous epithelium and the stroma displaying connective tissue proliferation and being liberally infiltrated with acute and chronic inflammatory cells.

　Among the various disorders of the infant where blood in the stool is observed, the rectal bleeding seen in juvenile intestinal polyposis is fresh, intermittent and relatively little in amount, thus making it rarely necessary to perform blood transfusion. Although diagnosis may be established in most instances by peranal digital palpation and rectoscopy for juvenile polyps frequently occur in the rectum or sigmoid, it is advisable to conduct double contrast barium enema and sigmoidoscopy in cases of juvenile polyp if suspected from the history of present illness.

　While frequently polypectomy can be accomplished by operation per anum, enterotomy or colectomy may be the treatment of choice in some cases. Juvenile polyps, unlike adenomatous polyps in adults, are generally believed only extremely rarely to have malignant potential. However in consideration of reported cases of recurrence several years after surgical removal, careful follow-up observation will be kept upon our recently treated patient in whom no sign of recurrence has yet been noted.