虫垂子宮内膜症による虫垂重積の1例

Appendiceal Intussusception Due to Endometriosis, Report of a Case

要旨●患者は40歳代，女性．便潜血陽性のため大腸内視鏡検査を受け，当科へ紹介され，受診となった．注腸X線造影検査および大腸内視鏡検査で，盲腸に表面平滑な隆起性病変を認め，広基性の基部から階段状，同心円状に先細りの形態を示していた．虫垂腫瘍による虫垂重積と診断し，腹腔鏡下回盲部切除術を施行した．虫垂と盲腸の筋層が肥厚し，内部に層状に虫垂粘膜を認め虫垂重積の状態であった．肥厚した筋層と漿膜下層内に子宮内膜間質に囲まれた子宮内膜腺を認め，虫垂子宮内膜症を原因として虫垂重積を来した病変であった．腸管子宮内膜症による虫垂重積は比較的まれで，術前診断は困難であるが，虫垂重積に特徴的な画像所見を呈しており，ここに報告する．

　A 40-year-old woman underwent colonoscopy and barium enema to further evaluate clinical findings of fecal occult blood. Results from the procedures demonstrated the presence of an elevated smooth lesion in the colon that tapered in a stepwise fashion from its base. Based on this finding, the intussusception of the appendix caused by an appendiceal tumor was suspected, and ileocecal resection was subsequently performed. Operative findings revealed the muscular layer of the appendix and cecum to be thickened and the appendix was found to be inverted into the cecum. Additionally, endometrial tissue was present within the thickened muscular and subserosa layers. Appendiceal intussusception due to intestinal endometriosis is a relatively rare condition, and pre-operative diagnosis can be quite difficult. Here we describe various radiographic and endoscopic findings characteristic of appendiceal intussusception.