腸重積をきたした盲腸子宮内膜症に対する腹腔鏡補助下回盲部切除術の1例

Laparoscopic-assisted ileocecal resection of cecal endometriosis with invagination of the intestine : a case report

◆要旨：患者は36歳，女性で，腹痛，腹満感を主訴に当院産婦人科を受診した．触診で右下腹部に腫瘤を触知した．腹部超音波およびCTで，上行結腸から盲腸にかけて腸重積を認めた．大腸内視鏡で腸重積を整復した．先進部は虫垂開口部であった．同部位に粘膜下腫瘍が疑われた．腹痛は改善したが，翌日再び腹痛が出現し腸重積の再燃を疑い緊急手術を施行した．術中所見では腸重積は自然整復していた．既往歴から腸管子宮内膜症が疑われ，腹腔鏡補助下に回盲部切除術を施行した．術後病理では盲腸子宮内膜症と診断した．同部位が大腸内視鏡で指摘された先進部と一致し腸重積の原因と判断した．腸重積をきたした盲腸子宮内膜症は稀な疾患である．今回，腸重積をきたした盲腸子宮内膜症に対して腹腔鏡補助下に回盲部切除術を施行し良好な結果がえられた症例を経験したので文献的考察を加えて報告する．

　The patient is a 36-year-old woman who visited the department of obstetrics and gynecology of our institute with the chief complaint of abdominal pain and abdominal distention. A tumor mass in lower right abdomen was found on palpation. Abdominal US and CT showed intussusception from the ascending colon to the cecum.

Although the intussusception was restored by CF, the possibility of submucosal tumor was suspected. The abdominal pain was relieved, but it reappeared the next day. Recurrence of intussusception was suspected and emergent surgery was performed. Intraoperative findings showed that the intussusception had been restored naturally and that there were two constriction sites in the ileum. From the patient's past history, cecal endometriosis was suspected and laparoscopic ileocecal resection was conducted. Pathologically, cecal endometriosis was diagnosed. This lesion coincided with the presenting portion indicated by CF and thus, it was considered as the cause of the intussusception. Cecal endometriosis manifesting intussusception is a rare illness. We report a patient with cecal endometriosis causing intussusception, treated successfully by laparoscopic-assisted ileocecal resection, with the literature review.