腹腔鏡下手術で治療しえた3か所の稀少部位に発生した子宮内膜症の1例

A case of endometriosis in three less common sites successfully diagnosed and treated under laparoscopic surgery

◆要旨：患者は43歳，女性．月経時に臍部からの出血を認め，当院産婦人科を受診した．腹部CTで臍部と虫垂に腫瘤影を認め，稀少部位子宮内膜症の疑いで手術を施行した．小切開下に臍腫瘤を摘出し，同部位よりportを挿入して気腹を行った．腹腔内を観察したところ，虫垂以外に回盲部より15cm口側の回腸にも白色調の腫瘤を認めたため，虫垂切除と回腸部分切除術を併施した．病理診断ではいずれも子宮内膜症と診断された．今回の回腸病変は腸閉塞や強い月経困難症につながった可能性があるが，術前検査では指摘できなかった．また，3か所の稀少部位に同時発生するものは非常に稀である．子宮内膜症は術前診断が困難な場合が多く，本症例では腹腔鏡下の腹腔内観察が確定診断，治療に有用であった．

We report a case of endometriosis of the ileum successfully diagnosed and treated under laparoscopic surgery. A 43-year-old woman was examined for bleeding from the umbilicus. She had a history of dysmenorrhea. Computed tomography（CT） imaging revealed a mass in the umbilical region and appendix. Based on preoperative diagnosis of umbilical and appendiceal endometriosis, we excised the umbilical tumor and inserted trocar from this site. Whitish tumor was found in the appendix and ileum. Laparoscopic partial resection of the ileum with appendectomy was performed. Pathological diagnosis confirmed endometriosis. The patient was discharged 6 days after surgery. Endometriosis that proliferated in three less common sites is rare. Since endometriosis is often asymptomatic, preoperative diagnosis is often difficult. Laparoscopy is useful in the diagnosis and treatment when endometriosis is suspected.