回盲部・虫垂病変の内視鏡診断

Endoscopic Diagnosis of Ileocecal and Appendiceal Lesions

要旨●回盲部・虫垂病変の内視鏡診断について，回盲部の炎症性疾患と腫瘍・腫瘍様病変，虫垂・虫垂開口部病変に分けて概説した．内視鏡観察において，回腸の腸間膜付着側と付着対側を認識することは重要であり，腸間膜付着側に病変を認める代表的疾患はCrohn病である．回盲弁開大の所見を呈する疾患として，腸結核と腸管Behçet病/単純性潰瘍が挙げられる．また感染性腸炎の特徴的な内視鏡所見を理解する必要がある．回盲部に好発する腫瘍性疾患の鑑別とともに虫垂開口部の所見にも留意する．また，虫垂杯細胞腺癌の終末回腸への浸潤による，盲腸底部の虫垂開口部の偏位の所見も重要である．

　We discussed the endoscopic diagnosis of ileocecal and appendiceal diseases, categorizing them into inflammatory diseases, tumors, and tumor-like lesions in the ileocecum and lesions at the appendix and appendiceal orifice. Endoscopic observation should identify the mesenteric and antimesenteric sides of the ileum. Crohn's disease is a representative disease observed on the mesenteric side. Intestinal tuberculosis, intestinal Behçet's disease, and simple ulcer are diseases accompanied by ileocecal valve opening. Moreover, understanding the characteristic endoscopic findings of infectious enterocolitis is necessary. The ileocecum tumor differential diagnosis and the appendiceal orifice findings should be focused upon. Additionally, results indicating cecal bottom displacement due to terminal ileum infiltration by goblet cell adenocarcinoma of the appendix must be recognized.