腹腔鏡下に診断しえた成人回腸異所性膵の1例

A case of adult ileal ectopic pancreas treated by laparoscopic-assisted surgery

◆要旨：患者は手術既往のない50歳の男性で下腹部痛を主訴として当院を受診した．腹部単純X線で小腸ガスの貯留と鏡面形成，腹部CTで骨盤部にtarget signがそれぞれみられ，径10mm大の小腸腫瘍が疑われた．イレウスが軽快したのち待期的腹腔鏡下観察を行った．回盲弁から約2mの回腸部に壁外に突出する10mm大の腫瘍を同定し，小開腹下に回腸部分切除術を行った．病理結果は異所性膵（HeinrichⅢ型）であった．術後経過は良好で腸閉塞の再発はみられていない．

　小腸の小腫瘍の診断に対して腹腔鏡的アプローチが有効であった．なお成人回腸異所性膵は稀な病態で，腹腔鏡補助下に切除した報告は自験例が初めてである．

　A 50-year-old man with no past surgical history complained of abdominal pain and visited our hospital. He was hospitalized for ileus and abdominal CT on admission revealed a target sign in the pelvic cavity, and ileal tumor was suspected. After the ileus improved, we performed laparoscopic operation, and extruded tumor, 1 cm in size and 2 m from ileocecal valve was detected. Partial resection of the ileum was performed. This tumor was pathologically diagnosed as groupⅢectopic pancreas according to Heinrich's classification. Adult ileal ectopic pancreas is rare entity and our laparoscopic-assisted resection is the first reported case in Japan.