カプセル内視鏡で発見され小腸内視鏡下マーキングにより安全に腹腔鏡補助下に切除しえた成人小腸重複症翻転の1例

Inverted small intestinal duplication in adult found by capsule endoscopy, marked by retrograde single balloon intestinal endoscopy, and safely treated by laparoscopic-associated surgery : a case report

◆要旨：小腸重複症は小児期発症が多い先天奇形であり，成人での発症は数少なく診断も難しい．今回筆者らは，従来は診断に難渋したであろう小腸重複症をカプセル内視鏡で発見し，小腸内視鏡下にマーキングして腹腔鏡補助下に切除するという低侵襲診断・治療に持ち込めたので報告する．摘出組織は粘膜から漿膜までを含む小腸壁全層が翻転した，これまで本邦では2例のみの報告がある翻転小腸重複症であった．小腸重複症は時々みられる疾患であるが，翻転小腸重複症のカプセル・小腸内視鏡診断ひいては腹腔鏡補助下手術による治療はこれまでに報告がなく，文献的考察を加え報告する．

　Small intestinal duplications are unusual anomalies that are difficult to diagnose. Most of them are diagnosed during childhood and they are rarely found in adults. We report here the 3rd case of inverted small intestinal duplication in Japan, diagnosed and treated by minimum invasive methods including capsule endoscopy, retrograde single balloon intestinal endoscopy, and laparoscopic-associated surgery. Resected tissue had all layers of small intestine that was wholly inverted into the intestinal lumen. Inverted small intestinal duplication diagnosed and treated by minimum invasive method has never been reported. Hence we report here with literature review.