小腸脂肪腫が原因で反復する腸重積症に対して腹腔鏡補助下に治療した1例

Recurrent intussusception due to jejunal lipoma diagnosed by double balloon endoscopy and treated by laparoscopy

◆要旨：患者は43歳，男性で，反復する腹痛を主訴に来院した．初診時の腹部CT検査では小腸重積を示唆する腸壁の重複像と先進部の脂肪濃度の腫瘤像が認められた．小腸造影では空腸に直径6cmの分葉状の軟らかい腫瘍を認めたが，それより肛門側の造影は不良であった．ダブルバルーン内視鏡施行時には重積は解除されていたが，軟らかい粘膜下腫瘍が確認され脂肪腫による腸重積と診断した．術中腹腔鏡による観察では約40cmにわたる空腸の再重積が認められ，腹腔鏡下に整復した．先進部の腫瘍を小切開創から腹腔外に引き出したところ脂肪腫が多発していたため，空腸を約7cm切除した．術前に脂肪腫と診断し得たことにより，腹腔鏡下手術で低侵襲に治療した1例を報告する．

　A 43-year-old man was admitted to our hospital with recurrent abdominal pain. Abdominal computed tomography revealed the multilayered structure of small intestine and intraluminal masses consistent with fat density. Although enterography demonstrated a soft intramural tumor, the passage of contrast media was delayed and visualizing the anal side of the intestine was difficult. Jejunal lipoma with intussusception was diagnosed using double balloon endoscopy. After exposing the abdominal cavity, we detected and laparoscopically reduced the invaginated jejunum by about 40 cm. Approximately 7 cm of the jejunum including the multiple lipoma was extracted from the abdominal cavity and resected. In conclusion, intussusception caused by multiple jejunal lipomas was treated with minimally invasive laparoscopy.