LECSにて切除した胃-胃重積を生じた胃穹窿部GISTの1例

Laparoscopic endoscopy cooperative surgery for gastrogastric intussusception due to huge gastrointestinal stromal tumor : A case report

◆要旨：胃重積は稀な消化管重積であり，特に胃-胃重積はきわめて稀である．今回，突然の左季肋部痛で発症した50mm大の胃GISTを先進部とした胃-胃重積に対し，腹腔鏡・内視鏡合同胃局所切除術（laparoscopic endoscopy cooperative surgery：以下，LECS）を施行した．症例は43歳，男性．朝食摂取4時間後に左季肋部痛を認め，CTで胃重積所見を認めた．緊急内視鏡検査で重積は解除されたが，胃穹窿部に50mm大の粘膜下腫瘍を認めた．非常に稀な胃-胃重積の原因となった50mm大のGISTに対して，LECSは低侵襲で有用な治療法であった．

　Gastrogastric intussusception is extremely rare in all gastrointestinal intussusceptions. We encountered a case of gastrogastric intussusception resulting from gastrointestinal stromal tumor （GIST） in a 45-year old man. The patient was admitted to the acute medical unit complaining of acute onset left epigastric pain. The characteristic pseudo kidney sign was observed on computed tomography. Upper gastrointestinal endoscopy revealed a large GIST 50mm in size. The endoscopy revealed that gastrogastric intussusception had been produced by a 50-mm tumor mass in the gastric antrum. With this diagnosis, laparoscopic endoscopy cooperative surgery （LECS） was performed. Histologic examination was an unusually large GIST. LECS was a useful operation to gastrogastric intussusception caused by GIST.