回盲部子宮内膜症による回腸狭窄に対し腹腔鏡補助下手術が有用であった1例

A case of ileal stenosis caused by ileocecal endometriosis successfully treated by laparoscopic assisted surgery

◆要旨：回盲部子宮内膜症による回腸狭窄に対して腹腔鏡下手術で治療した症例を経験したので報告する．患者は40歳，女性．2004年2月より月経随伴性の腹痛，嘔気に対しホルモン療法（leuprolein）で軽快していた．2005年9月，挙児希望があり，精査加療目的に当院消化器内科を紹介され，回盲部狭窄を認めたため手術目的で外科紹介となった．腹部CT検査では回腸末端は腸管壁の肥厚を伴う狭窄像を呈していた．小腸鏡検査では，回腸末端粘膜は発赤調で狭窄を認めていた．腹腔鏡補助下回盲部切除を施行した．病理組織学的検査所見では狭窄部位は線維性に肥厚し，筋層内に内膜腺組織を認め回盲部子宮内膜症の診断であった．本疾患に対する低侵襲の腹腔鏡下手術は治療上非常に有用と考えられた．

　We report a case of ileal stenosis caused by ileocecal endometriosis successfully treated by laparoscopic assisted ileocecal resection. A 40-year-old woman complained of abdominal pain associated with menstruation and was suspected to have intestinal endometriosis. She was referred to the Department of Gastroenterology at Jichi Medical University Hospital for further investigation and treatment. Abdominal CT showed a dilated terminal ileum with a thickened intestinal wall. Double balloon enteroscopy revealed ileal stenosis with a smooth reddish mucosal surface. Gonadotropin-releasing hormone agonist therapy improved her symptoms, but she wanted to have children in the near future. Therefore the patient was referred for surgical therapy to have a laparoscopic assisted ileocecal resection. Pathological diagnosis of the resected specimen was compatible with ileal endometriosis. Minimally invasive surgery is an ideal treatment for intestinal endometriosis in selected patients.