憩室様病変およびMeckel憩室

Diverticular Lesions

　与えられた主題は十二指腸球部以下で憩室様所見を呈する病変ということであるが，憩室については本誌の中で他の著者により詳しく述べられることと思うので，本稿では憩室ないしそれとの比較には触れず憩室様膨出を示す病変についての考察と，いくつか代表的症例を供覧することにより，その責を免れたい．

　憩室様所見は，所見そのものが病変である場合と，局在病変の周辺間接所見としてあらわれる場合および系統疾患の一部分所見としてあらわれるものとがある．したがってここでいう憩室様所見は，真の憩室とは臨床的意義を全く異にする．すなわち異常な憩室様膨出所見が認められた場合，その原因を十分検索することが大切であり，そのことのほうが憩室（真性，仮性）自身をみつけるよりも臨床的意義は大きいといえる．

　Several cases are illustrated here that showed on x-ray diverticular protrusions distal to the duodenal bulb. We have also attempted to classify them according to their etiologies: (1) transient protrusion due to functional disturbances; (2) eccentric dilatation caused by contraction of ulcer in its scarring stage; (3) diverticulum resulting from weakened intestinal wall itself in systemic diseases; (4) formation of cul-de-sac cyst, due to either (A) congenital Meckel's diverticulum or (B) aftermath of surgical operation; and (5) ulcer or fistula itself.

　The first in the above divisions is seen either when barium is retained in a part of the normal colonic haustra or it is eccentric haustra themselves. The second is observed in ulcerous lesions over Ul-Ⅱ depth in Crohn's disease or tuberculosis. The third is intestinal lesion in collagen diseases. We have also referred to the distinction between diverticulitis and cancer, a problem that is expected to become more important in the future. It is based on a review of the literature concerned, despite the fact that so far we have never experienced such a case. A survery of Meckel's diverticulum has been made as well.