診断が困難で腹腔鏡補助下に回盲部切除した退縮性腸間膜炎の1例

A case of undiagnosed retractile mesenteritis resected by laparoscopic ileocecal resection

◆要旨：診断が困難で，腹腔鏡補助下回盲部切除により診断した退縮性腸間膜炎の1例を報告する．患者は70歳，女性．右下腹部痛と下痢を主訴に当院を受診した．理学的所見では右下腹部に軽度の圧痛があった．血液検査では可溶性インターロイキン-2レセプターが高値である以外は正常で，炎症反応もなかった．CTとMRI検査では回盲部の腸間膜に孤立性の腫瘤像を認め，FDG-PET検査では腫瘤にFDGの異常集積を認めた．悪性腫瘍との鑑別が困難なため，腸間膜腫瘤を含めて腹腔鏡補助下回盲部切除を施行した．病理検査で腫瘤は退縮性腸間膜炎と最終診断された．退縮性腸間膜炎は原因不明できわめて稀な腸間膜の炎症性疾患であり，その診断は困難である．今回の症例から本疾患の診断と治療に低侵襲な腹腔鏡下手術が有用であると考えられた．

We report a case of undiagnosed retractile mesenteritis diagnosed by laparoscopic ileocecal resection. A 70-year-old woman was admitted to our hospital with complaints of right lower abdominal pain and diarrhea. Physical examination revealed slight tenderness without a palpable tumor in her right lower abdomen. Laboratory data were normal except for elevated level of soluble interleukin-2 receptor. CT and MRI of the abdomen showed a solitary mass of ileocecal mesentery. FDG-PET showed FDG accumulation in the mass. Laparoscopic ileocecal resection was performed because differential diagnosis was difficult with malignant tumors. Pathological findings were inflammatory change of the mesentery with marked fibrosis and final diagnosis was retractile mesenteritis. Retractile mesenteritis is a rare idiopathic inflammatory disorder of the mesenteric adipose tissue with unknown etiology and a difficult disease to diagnose. We concluded that laparoscopic examination for diagnosis and treatment is useful for this disease.