成人腸重積合併小腸GISTに対する腹腔鏡補助下手術の1例

Intussusception due to jejunal GIST treated by laparoscopic surgery

◆要旨：患者は74歳の女性で，4～5年前から時々上腹部痛を認めたが，最近痛みの回数が増加し，腸閉塞の診断で入院となった．絶食して経過をみたが，腹痛が続いたために入院3日後に腹部CT検査を施行した．腹部CT検査では肥厚した小腸壁の内部に腸間膜様の低吸収域を認め腸重積と診断した．同日，腹腔鏡補助下に手術を施行した．手術は腸重積整復と小腸部分切除術を行った．3.5×2.5×2.0cmの腸管内隆起型粘膜下腫瘍を認めた．病理組織学的所見ではgastrointestinal stromal tumor（GIST）であった．術後経過は良好で術後16日目に退院した．小腸GISTによる腸重積症に対する腹腔鏡補助下手術は有用な術式と考えられた．

　A 71-year-old woman was admitted to our hospital with a diagnosis of ileus. The patient sometimes complained of upper abdominal pain for the past 4 or 5 years and the frequency of the pain recently increased. The patient was first treated by fasting, but the abdominal pain continued. Abdominal CT taken on the third day after admission showed a mesenterium-like low density area into the lumen of the hypertrophic small intestine. She was diagnosed as having intussusception. On the same day, laparoscopy-assisted surgery was performed, reducing the intussusception and partly resecting the jejunum. . Resected specimen showed a submucosal tumor of 3.5×2.5×2.0 cm that bulged into the lumen of the jejunum. Pathological examination was GIST. The patient left the hospital on the 16 postoperative day and is recovering well. The laparoscopy-assisted surgery for intussusception due to jejunal GIST may be considered as a useful operative method.