虫垂内腫瘍で発見された虫垂子宮内膜症の1例

Appendiceal Intussusception by Endometriosis, Report of a Case

要旨　患者は63歳，女性．大腸がん検診で便潜血検査陽性を指摘され，当センターを受診した．大腸内視鏡検査で挿入困難であったため，同日注腸X線造影検査を行ったところ，短縮した虫垂内にイモ虫状で細長い，大きさ約2cmの隆起性病変を認めた．再検査の大腸内視鏡検査では，虫垂入口部には異常所見を認めなかったが，生検鉗子を用いて入口部を広げると，発赤した表面平滑な隆起性病変が蠕動に伴って虫垂口から盲腸に脱出する様子が観察された．超音波内視鏡および造影CT検査を行ったが質的診断には至らず，虫垂原発の粘膜下腫瘍と診断し，右下腹部の慢性的な鈍痛の原因になりうることや悪性も完全には否定できないことから，腹腔鏡下虫垂切除術を施行した．病理組織学的検討から，虫垂体部に発生した子宮内膜症が虫垂重積を来し，それによってポリープ状の粘膜下腫瘍様病変が形成されたものと診断した．

　A 63-year-old woman visited our center because of a positive fecal occult blood test. Barium enema examination revealed a smooth, elevated lesion in the shortened appendix ; the lesion was approximately 20mm in diameter and resembled a green caterpillar. Endoscopic examination revealed normal appendiceal orifice and an elevated lesion covering the normal mucosa from the orifice. Based on the X-ray examination and endoscopic findings, the patient was diagnosed as having a submucosal tumor of the appendix. Therefore, a laparoscopic appendectomy was performed. On the basis of pathological findings, this case was diagnosed as appendiceal intussusception associated with endometriosis. Considering the clinical information and other imaging findings as well as appendiceal circumference, it was concluded that appendiceal mass lesions may be correctly diagnosed as cases of intussusception, or not, using a barium study.