小腸内視鏡で下血部位を同定し腹腔鏡補助下に切除した空腸inflammatory fibroid polypの1例

Inflammatory fibroid polyp of the jejunum detected by double-balloon endoscopy and treated by laparoscopy-assisted surgery : a case report

◆要旨：患者は25歳，男性．2006年9月下旬，上腹部痛を自覚し，下血による意識消失で前医に搬送された．上部・下部消化管内視鏡検査，CT，シンチグラフィを受けたが出血源は不明であった．10月下旬に再度下血を認め，当院に転院となった．小腸内視鏡検査にてトライツ靭帯から約1mの空腸に粘膜下腫瘍を認めたため，腹腔鏡補助下小腸部分切除術を施行した．術後の病理組織検査にて空腸inflammatory fibroid polyp（以下，IFP）と診断された．小腸IFPは比較的稀な疾患であり，その多くは腸重積を生じ，腸閉塞の診断で開腹手術されている．今回，筆者らは下血を主訴に発症し，術前の小腸内視鏡検査で存在診断でき，腹腔鏡補助下に切除しえた小腸IFPの1例を経験したので報告する．

　We report a patient with inflammatory fibroid polyp（IFP）of the jejunum detected by double-balloon endoscopy and treated by laparoscopy-assisted surgery.

A 25-year-old man was conscious of the upper abdominal pain in the end of September, 2006. He was admitted to the hospital because of loss of consciousness caused by a massive bloody stool. At that time, no bleeding site could be detected by gastrointestinal endoscopy, colonoscopy, CT, or scintigraphy. In the end of October, he was transferred to our hospital because of another bloody stool. Double-balloon endoscopy performed at our hospital revealed a submucosal tumor in the jejunum about 1 m apart from the Treitz ligament. Laparoscopy-assisted partial resection of the jejunum was performed. Histopathologically, it was diagnosed as IFP of the jejunum. IFP of the small intestine is relatively rare and the majority of the lesions occur in the ileum rather than the jejunum. Patients often present with signs of small intestinal obstruction caused by intussusception in which case it would be treated by open surgery. This rare case with a bloody stool was properly treated by laparoscopy-assisted surgery since the tumor was detected by preoperative double-balloon endoscopy.