腹腔鏡下切除を施行した悪性リンパ腫に起因した腸重積症の1例

Intussusception in an adult caused by malignant lymphoma of the ileum : a successful treatment by laparoscopically-assisted surgery

◆要旨：患者は67歳，男性．胃癌手術の既往があり，腹痛を主訴に入院した．腹部超音波，腹部CTで腸重積と診断した．大腸内視鏡検査では上行結腸に重積先進部を認めた．翌日，重症化が予想され腹腔鏡による緊急手術となった．胃切除の癒着のない側腹部でポートを留置し重積腸管を確認し，悪性腫瘍も考慮し血管切除を含めた右結腸切除術を施行した．病理検索により回腸原発の悪性リンパ腫と診断され，化学療法を行った．腹腔鏡下手術は悪性リンパ腫においても開腹手術と比べて遜色なく，また低侵襲で整容性の点からも有用と考えられた．

　A 67-year-old man was admitted to our hospital with abdominal pain, seven years after distal gastrectomy for gastric cancer. Ultrasonography revealed a multiple concentric ring sign with a hypo echoic area in the center and computed tomography demonstrated a target sign. Colonoscopic examination revealed an intussusception with the tumor in the lead. Small bowel intussusception was diagnosed. On the next day, the patient fell to leucopenia and urgent laparoscopic-assisted right hemicolectomy was performed. The histopathological findings showed that the tumor was a malignant lymphoma of the diffuse large B-cell type. R-CHOP therapy was added after operation, and the patient is alive for 10 months postoperatively. Although adult intussusception is very rare, the presence of malignancy should be considered and proximal vascular pedicle ligation should be performed. Recent studies describing the outcomes of laparoscopic resection of colon cancer support a similar approach for ileocaecal or colocolic intussusception, regardless of the pathology.