腹腔鏡下回盲部切除術を行った虫垂間膜脂肪織炎の1例

A case of panniculitis of mesoappendix treated by laparoscopic ileocecal resection

◆要旨：患者は79歳，男性．右下腹部痛を主訴に来院した．右下腹部に圧痛を伴う弾性硬の腫瘤を触知した．CTと超音波検査にて盲腸を壁外より圧排する腫瘤影を認めた．大腸内視鏡検査では盲腸に粘膜面の変化を認めなかった．以上の所見より虫垂腫瘍を否定できず，腹腔鏡下に観察を行ったところ，虫垂に一致する部位に鶏卵大の硬い腫瘤を認め，回腸末端部が巻き込まれて癒着していた．虫垂癌の小腸浸潤も否定できず，en-blocに切除した．切除標本では虫垂を厚い脂肪組織が取り囲んでおり，病理組織学的には虫垂組織の構造はほぼ保たれ，虫垂間膜と思われる脂肪組織内に炎症細胞浸潤と線維芽細胞の増殖を認め，虫垂間膜脂肪織炎と診断した．

　A 79-year-old man was admitted to our hospital with the chief complaint of right lower abdominal pain. An elastic hard tumor accompanied by tenderness was palpated in the right lower abdomen. CT and ultrasonography detected an extrinsic tumor compressing the cecum. No changes were noted in the cecal mucosa on colonoscopy. Since the above findings could not exclude the possibility of appendicular tumor, laparoscopic observation was performed, and a chicken egg-sized hard tumor was found in the region corresponding to the appendix. The ileal end region was involved and adhered. Since small intestinal invasion by cancer of the appendix could not be ruled out, en-bloc excision of the lesion was performed. In the excised specimen, thick adipose tissue surrounded the appendix. Histologically, the appendix tissue was mostly retained, and inflammatory cell infiltration and fibroblast proliferation were noted in the adipose tissue, which may have been the mesoappendix. Based on these findings, the lesion was diagnosed as panniculitis of the mesoappendix.