虫垂憩室出血の1例

Bleeding from the Diverticula of the Appendix, Report of a Case

要旨　患者は40歳，男性．血便を主訴として当科を受診し，2か月間に2回の血便を繰り返した．いずれの出血時にも出血源は不明であったが，注腸X線検査で虫垂に多発憩室が描出されていた．3回目の血便の際に施行した経口腸管洗浄液による前処置後の全大腸内視鏡検査で，虫垂開口部から持続する出血を確認し，虫垂憩室出血と診断した．虫垂切除術施行後は再出血なく退院した．切除標本の病理組織学的検査では，多発憩室のうち1つに小動脈壁破綻が認められ，出血源の可能性が考えられた．虫垂憩室は比較的まれな疾患であるが，下部消化管出血の原因として念頭に置くべき疾患と考えられた．

　A 40-year-old man visited our hospital in September, 2003, complaining of repeated hematochezia. He had experienced similar episodes of bleeding during the preceding two months. Although various imaging procedures failed to identify any source of bleeding, barium enema examination had shown that the patient had diverticula of the appendix. Colonoscopy performed at the time of the latest episode of hematochezia showed fresh blood oozing from the appendiceal orifice. Based on those findings, we diagnosed the patient as bleeding from diverticula of the appendix. Histological examination of the resected appendix revealed diverticula of the appendix, in which a ruptured artery was also noticed. Our case suggests that the appendiceal diverticula should be seriously considered as a possible source of bleeding in patients with obscure gastrointestinal bleeding.