腸重積症の発症により腹腔鏡補助下に切除しえた若年成人悪性リンパ腫の1例

Small bowel intussusception caused by malignant lymphoma treated with laparoscopic surgery

成人腸重積症の発症により腹腔鏡補助下に切除し得た回腸悪性リンパ腫の1例を経験したので報告する．症例は31歳，男性．主訴は下腹部痛．右下腹部に圧痛のある硬い腫瘤を蝕知し，腹部超音波検査でmultiple concentric ring signとhay-folk signを，腹部CTでtarget signと腹腔内リンパ節の腫大を認めたため，腸重積症と診断し手術を施行した．回腸に腫瘤を触知し回結腸リンパ節の腫大を認めたため，腹腔鏡補助下右半結腸切除術（D3）を施行した．回腸に粘膜下腫瘍を認め，病理組織所見の結果，悪性リンパ腫diffuse large B cell lymphomaと診断した．

　We report herein a case of small bowel intussusception caused by malignant lymphoma treated with laparoscopic surgery. A 31-year-old man presented with chronic right lower abdominal pain. A hard tumor was palpable and tender in the right lower quadrant. Ultrasonography demonstrated multiple concentric ring sign and hay-folk sign, and computed tomography revealed a target sign and swollen iliocolic lymph nodes. Small bowel intussusception of unknown origin was diagnosed, and laparoscopic surgery was performed. The tumor was detected in the ileum and considered as malignant tumor due to swollen lymph nodes, so laparoscopic assisted right hemi colectomy（D3）was performed. Histopathological examination revealed malignant lymphoma（B-cell type）in the ileum. Postoperative course was uneventful, so the patient was discharged 13 days postoperatively. Laparoscopic surgery seemed useful for small bowel intussusception in an adult.