腹腔鏡下に切除した未破裂右胃大網動脈瘤の1例

Laparoscopic resection of unruptured right gastroepiploic arterial aneurysm : A case report

◆要旨：患者は64歳，女性．血尿のために近医で施行されたCTにて，胃の大彎側に接する7mm大の腫瘤を認め，精査目的に当院を紹介され受診した．腫瘤は右胃大網動脈上にあり，造影CTにて早期濃染され，超音波検査にて拍動性の血流を認めたことから，未破裂右胃大網動脈瘤と診断した．1か月の間に長径が7mmから9mmに増大し，腹腔鏡下動脈瘤切除を施行した．病理組織にてsegmental arterial mediolysis （SAM）と診断した．胃大網動脈瘤未破裂例に対する腹腔鏡下動脈瘤切除は，低侵襲なうえに比較的容易であり，病理診断も可能となるため，有用な治療法と考えられた．

A 64-year-old woman was referred to our hospital because a tumor, 7 mm in diameter, was incidentally found near the stomach on abdominal CT. The tumor was strongly enhanced on contrast-enhanced CT, and color Doppler echography showed blood flow. Based on these findings, we diagnosed it as unruptured right gastroepiploic arterial aneurysm. The diameter of the aneurysm increased from 7 mm to 9 mm within a month, and laparoscopic resection was performed. Histological examination revealed that the aneurysm was due to segmental arterial mediolysis（SAM）. Laparoscopic resection of the unruptured right gastroepiploic arterial aneurysm is effective because it is minimally invasive, not too difficult to perform and enables histological examination.