腹腔鏡下手術で摘出した自然破裂後に再腫大したCA 19-9産生性脾囊胞の1例

Spontaneous rupture of a CA 19-9 producing splenic cyst operated by laparoscopic surgery : a case report

◆要旨：CA 19-9産生性脾囊胞の自然破裂例を経験した．患者は34歳，男性．突然の腹痛を主訴に当院救急外来を受診した．臍中心に圧痛を認め，腹部CTにて肝表面に腹水，変形した脾囊胞を認め，脾囊胞破裂に伴う腹膜炎と診断し，入院経過観察とした．症状は軽快し，退院をしたが，脾囊胞は再び増大し，高CA 19-9血症を伴った．再破裂の可能性が考えられ腹腔鏡下手術を施行した．胃脾間膜，脾結腸間膜を切離し，脾下極の脾動静脈分枝を切離した．脾門はハンドアシスト下に血管用自動縫合器を使用し一括切離，脾を摘出した．術後経過良好で，血清CA 19-9値も正常化した．病理組織学的所見は，囊胞内面は扁平上皮と円柱上皮に被覆される脾上皮性囊胞と診断された．

　We report a case of spontaneous rupture of a CA 19-9 producing splenic cyst. A 34-year-old man experienced abdominal pain with sudden onset. An abdominal CT scan revealed perihepatic ascites and deformation of the splenic cyst. A diagnosis of peritonitis due to the ruptured splenic cyst was made. Although the abdominal pain disappeared, the primary cyst increased in size, along with high level of serum CA 19-9. Laparoscopic assisted splenectomy was planned to prevent further rupture. The gastrosplenic ligament and splenocolic ligament were divided by ultrasonically activated device, and the splenic artery and vein were divided using a vascular auto suture apparatus under hand assisted technique. Post operative course was uneventful, and serum CA 19-9 level normalized. The inner surface of the cyst was covered with squamous and columnar epithelium, which was diagnosed as epithelial.