内視鏡整復後に腹腔鏡補助下回盲部切除を行った腸重積合併回腸悪性リンパ腫の1例

A laparoscopy-assisted ileocecal resection for ileal malignant lymphoma with intussusception after replacement by colonoscopy

◆要旨：患者は14歳，男児．3週間来の腹痛にて来院した．腹部超音波検査，CT検査にて腹部腫瘤を認め，横行結腸まで及ぶ腸重積を認めた．注腸での整復は困難であった．先進部精査も含めて大腸内視鏡検査を施行した．横行結腸に4cm大の腫瘍性病変を先進とする腸重積を認め，盲腸部まで整復し得た．回腸腫瘍を先進部とする腸重積の不完全整復のもとに，手術を施行した．腹腔鏡にて回腸の腸重積を認め，回盲部を授動後，小開腹して腸重積を徒手整復した．腫瘍は漿膜面にひきつれを伴う悪性腫瘍と診断し，回盲部切除術を施行した．術後の病理診断は悪性リンパ腫であった．腸重積を伴う回盲部腫瘍の診断，治療に大腸内視鏡および腹腔鏡下のアプローチは有用と考えられた．

　The patient was a 14 year-old boy with a chief complaint of continuous abdominal pain lasting for three weeks. A big mass was palpable in the right mid abdomen. Bowel intussusception up to the transverse colon was suspected by ultrasonography and computed tomography（CT）. The intussusception could not be treated by barium enema. By colonoscopy, a tumor measuring 4 cm in diameter at the head of the invaginated bowel was detected in transverse colon and it was pushed back to the cecum. With the diagnosis of tumor-led ileal intussusception with incomplete replacement, laparoscopic surgery was performed. Laparoscopy showed the terminal ileum invaginated into the cecum. After a small incision of the abdomen, invagination was manually treated and a malignant tumor with serosal shrinkage was detected. lleocecal resection with D 2 lymphadenectomy was performed. The pathology of resected specimen showed a malignant lymphoma in the terminal ileum. In conclusion, combined endoscopic and laparoscopic approaches were useful for the diagnosis and treatment of intussusception caused by ileocecal tumors.