術前診断し腹腔鏡補助下に治癒しえた多発回腸脂肪腫による腸重積症の1例

A case of intussusception due to multiple ileal lipoma treated with laparoscopically-assisted surgery

症例は72歳の女性．腹痛，嘔吐を主訴として来院し，腸閉塞の診断で入院となった．腹部CT検査で回腸は拡張し，内部にfat densityの腫瘤が集簇している像を認めた．大腸内視鏡検査で回腸が盲腸内に重積しており，重積先進部に表面平滑で，黄色および赤色調の多発した粘膜下腫瘍を認めた．以上の所見より，多発回腸脂肪腫による腸重積症と診断し腹腔鏡補助下回盲部切除術を施行した．漿膜面に発赤を伴い膨隆した回腸が，回盲弁から約10cmの部位まで重積していた．病理組織学的には良性の脂肪腫であった．画像診断の進歩に伴い，小腸脂肪腫は術前診断されることが多い．したがって，低侵襲である腹腔鏡補助下手術は良性脂肪腫による腸重積症に対して有用な治療法であると思われた．

　We report a case of adult intussusception due to multiple ileal lipoma treated with laparoscopically-assisted surgery. A 72-year-old woman was admitted to our hospital with the diagnosis of small intestinal obstruction. Abdominal computed tomography demonstrated aggregated fat density tumors in the dilated ileum. Colonoscopy showed ileal intussusception into cecum and multiple smooth surfaced yellowish tumors. We performed laparoscopic-assisted ileocecal resection with the diagnosis of intussusception due to multiple ileal lipoma. Histopathological examination revealed multiple benign lipoma. Recently, it has been reported that intussusception caused by small intestinal lipoma was diagnosed preoperatively because of the progress in radiological and endoscopic modalities. Therefore, laparoscopic surgery is recommended for small intestinal lipoma as less invasive procedure.