腹腔鏡補助下に切除した著明な拡張を認めた成人回腸重複症の1例

Enlarged ileal duplication treated by laparoscopy-assisted surgery in an adult

◆要旨：患者は53歳，男性．S状結腸癌の術前に，CTおよびMRIにて骨盤内に小腸に接して13cm大の囊腫様病変を認めた．囊胞内は均一で，内部に腫瘍の合併を疑う所見は存在しなかった．腹腔鏡による観察にて，囊腫様病変は遠位回腸の腸間膜内に存在し，壁が腸管様で回腸重複症と判断した．術中超音波検査で重複腸管内部に隆起性病変がないことを確認のうえ，内容物を漏出させないよう穿刺吸引を行った．囊腫様病変は著明に縮小し，腹腔鏡補助下に回腸部分切除およびS状結腸切除（D3郭清）を施行した．組織学的に，重複腸管内には腫瘍病変は存在しなかった．S状結腸癌はStage Iの最終診断であった．経過良好で，術後2年3か月現在，結腸癌の再発なく健存である．

A large cystic lesion, measuring 13cm in size, was discovered near the small intestine by preoperative CT and MRI scans for sigmoid colon cancer in a 53-year-old man. Laparoscopy showed the cystic lesion that was located in the mesentery of the distal ileum and that contained intestine-like wall. The lesion was diagnosed as ileal duplication. Intraoperative ultrasonography revealed no polypoid lesion inside the ileal duplication. The content of the duplication cyst was aspired without leaking the content and then partial resection of the ileum was performed laparoscopically. Laparoscopy was useful to diagnose the duplication of the alimentary tract. If malignancy is ruled out, laparoscopic surgery is a feasible method to treat remarkably enlarged cystic duplication by using appropriate devices.