著明な貧血を呈し腹腔鏡下手術を施行した小腸リンパ管腫の1例

A case of lymphangioma of the small intestine with severe anemia resected by laparoscopic surgery

◆要旨：患者は38歳，男性．1週間前からの頭痛，めまいを主訴に近医を受診し，著明な低色素性貧血を認め当院へ紹介された．腹部CTにて骨盤腔内に径9cmの造影効果に乏しい多房性腫瘤影を認めた．上部消化管内視鏡検査，および小腸造影検査では明らかな異常は認めず，下部消化管内視鏡検査では終末回腸にタール便の付着を認めた．腸間膜腫瘍の小腸穿破，または小腸腫瘍の疑いで腹腔鏡下に手術を行った．手術所見ではTreitz靱帯から約150cmの空腸に手拳大の腫瘍を認め，腹腔鏡下に切除した．病理組織学的検査では小腸リンパ管腫と診断された．リンパ管腫は非上皮性の良性疾患であり，小腸に発生することは稀である．

　A 38-year-old male was referred to our hospital with severe anemia. Physical examination was unremarkable abdominal mass, but abdominal CT demonstrated a large polycystic mass in the pelvic cavity. While the bleeding focus could not be pointed out by upper gastrointestinal endoscopy and radiography of the small intestine, tarry stool was observed in the terminal ileum by total colonoscopy. These findings supported the diagnosis of small intestinal or mesenteric tumor for which laparoscopic excision was performed. A large, polycystic mass was seen at the jejunum, approximately 150cm distal from the Treitz's ligament. The histopathological diagnosis was lymphangioma of the small intestine. A lymphangioma of the small intestine is a rare benign tumor which often causes gastrointestinal bleeding.