腹腔鏡による腹腔内観察が治療に有効であった小児小腸ポリープによる腸重積症の1例

Laparoscopic-assisted surgery for intussusception due to benign polyp of jejunum in a child

◆要旨：患者は12歳，女児．腹痛・嘔吐を主訴に当院を受診した．右下腹部に手拳大の腫瘤を触知し，造影超音波検査で約4cmの小腸ポリープを先進部とした腸重積症と診断し手術を施行した．腹腔鏡下にて腹腔内を観察すると，トライツ靭帯より約100cm肛門側の空腸に腸重積を認めた．空腸重積部は体外にて用手整復し，先進部の小腸ポリープを含めて，空腸部分切除術を施行した．小腸腫瘍の術前質的診断に造影超音波検査は有用であった．腹腔鏡は，病変の診断および適切な開腹位置の決定に役立ち，手術創を無駄に大きくすることなく低侵襲であることから大変有効であると考えられた．

　Benign tumor of the small intestine is rare and it is difficult to diagnose accurately. We report a child with intussusception due to benign polyp of the jejunum that was successfully treated by　laparoscopic-assisted surgery. A12-years-old child was admitted to our hospital complaining of abdominal pain and nausea without any previous surgical history. She was diagnosed as having intussusception due to benign tumor of the jejunum by enhanced abdominal ultrasonography using new enhancing agent, Sonazoid. Diagnostic and therapeutic laparoscopic-assisted surgery was performed. Partial resection of the jejunum was performed with the diagnosis of intussusception due to benign tumor. Histopathological examination revealed this benign tumor to be Peutz-Jeghers type polyp.