粘膜下腫瘍として腹腔鏡補助下に切除したS状結腸子宮内膜症の1例

A Case Report of Sigmoid Endometriosis Resected Laparoscopically as a Submucosal Tumor

　大腸粘膜下腫瘍の術前診断にて腹腔鏡補助下結腸部分切除を行い，腸管子宮内膜症と判明した1例を経験した．患者は33歳，経産婦で，不定期な下痢と体重減少を主訴に来院し，S状結腸に2cm径の粘膜下腫瘍が見いだされた．症状と腫瘍との関連は不明であったが，各種検査にても確定診断に至らず，悪性腫瘍の可能性を否定できないため腹腔鏡補助下に切除した．術後経過は良好で，下痢は消失し体重増加をみた．結果的にminimal accessで診断確定とともに治癒せしめ得ただけでなく，骨盤腔の十分な観察から他に同様の病変がないことを確認できた．大腸粘膜下腫瘍に対する内視鏡下手術の有用性を示す好例と考え，文献的考察とともに報告した．

A 33-year-old secundipara with sigmoid endometriosis treated laparoscopically is reported. She consulted a gastroenterologist with chief complaints of irregular diarrhea and body weight loss. Barium enema revealed a sigmoid submucosal tumor 2 cm in diameter which was confirmed by colonofiberscopy but failed to be diagnosed histologically by biopsy. Endosonographic study showed that the tumor was hypoechoic and originated in the tunica muscularis coli, suggesting a myogenic tumor. Laparoscope-assisted segmental colectomy was performed because of a possibility of malignancy.