腹腔鏡下に切除した後腹膜静脈性血管腫の1例

Laparoscopic resection of retroperitoneal venous hemangioma : A case report

◆要旨：患者は45歳，男性．統合失調症にて当院精神神経科に通院していた．背部痛で近医を受診し，CT検査にて十二指腸下行脚の背尾側に4cm大の低吸収域を認めた．病変はCT検査で経過観察中に増大傾向を示し，超音波内視鏡下穿刺吸引法による生検などの検査を試みたが鎮静困難で中止となった．侵襲的検査が困難で手術目的に当科へ紹介となり，腹腔鏡下に後腹膜腫瘍を切除した．腫瘍は暗赤色の囊腫状で，周囲組織への浸潤は認めなかった．術後病理診断では静脈性血管腫の診断となった．後腹膜腫瘍，そのなかでも後腹膜血管腫は稀な疾患である．術前診断は困難なことが多く，腹腔鏡下に切除した症例は非常に稀であるため，報告する．

A 45-year-old man with schizophrenia has been attending the department of psychiatry in our hospital regularly. He visited a local hospital complaining of back pain. Computed tomography revealed a low density area, 4cm in diameter, in the dorsal and caudal side of the descending part of duodenum. The lesion increased in size during observation by computed tomography. Biopsy by endoscopic ultrasound fine needle aspiration was attempted. However the examination was withdrawn due to difficulty of putting the patient under sedation. Because invasive examination was not possible, the patient was referred to us for surgical intervention, and retroperitoneal neoplasm was treated by laparoscopic surgery. The tumor was a wine-colored cyst without any invasion to the surrounding tissue. Histopathological diagnosis was venous hemangioma. Retroperitoneal neoplasm is uncommon, especially retroperitoneal hemangioma which is extremely rare. It is difficult to diagnose before the operation, and there have been only few reported cases of retroperitoneal venous hemangioma resected by laparoscopic surgery.