術前診断しえた成人回腸非交通型重複腸管に対し腹腔鏡補助下に切除した1例

Laparoscopically assisted surgery for preoperatively-diagnosed adult intestinal duplicate : A case report

◆要旨：患者は40歳，女性．約1年7か月前に不正出血で産婦人科を受診し，超音波検査で骨盤内に囊胞性病変を認め，近医内科紹介となった．腹部超音波検査で囊胞壁の蠕動を認め，当院紹介となった．小腸内視鏡で壁外性の圧排を認め，超音波内視鏡で内腔にdebrisの貯留した腫瘤を認めた．造影剤含有の経口腸管洗浄剤を用いた腸管内造影CTで病変部と腸管の交通を認めなかった．非交通型回腸重複腸管と術前診断し，腹腔鏡補助下小腸切除術を施行した．経過良好で術後8日目に退院となった．組織学的検査で囊胞壁は隣接している腸管と固有筋層を共有していた．疾患概念を念頭に置いた術前診断と腹腔鏡補助下の手術を行うことで，多発病変の有無の検索とともに整容性の高い低侵襲の手術が可能であった．

　A 40-year-old woman had a medical examination in local hospital because of abnormal vaginal bleeding. Endometrial polyp and cystic lesion with fluid in the pelvis were detected by ultrasonography. She was introduced to a nearby medical clinic. An abdominal ultrasonography revealed intestinal peristalsis of the cystic wall. In our hospital, intestinal endoscopy detected extrinsic compression of the ileum and endoscopic ultrasonography showed cystic lesion with debris. Intra-intestinal contrasted CT utilizing whole bowel irrigation with water-soluble contrast agent found no influx of contrast agent into the pelvic cyst. Preoperative diagnosis was intestinal duplicate and laparoscopically assisted surgery was performed. Laparoscopy showed that the cystic lesion was adjacent to the ileum at the mesentery side about 100cm proximal from the ileum end. Partial resection of the small bowel including the cystic lesion was performed. Histological findings revealed that the cyst shared the muscular layer with the intestine, diagnosed as an intestinal duplicate. The patient was discharged without any complication 8 days after the operation. Adult intestinal duplicate is relatively rare and it is a good indication for laparoscopically assisted surgery because of esthetic and minimally invasive outcomes.