潰瘍形成を繰り返し出血性ショックに至った胃異所性膵をCLEAN-NETによって切除した1例

A case of gastric aberrant pancreas with ulcer formation and bleeding treated by CLEAN-NET

◆要旨：患者は59歳，男性．前医にて腹痛の精査を受け，潰瘍と急性膵炎を伴う胃異所性膵と診断され，その後9年間，同様のエピソードを繰り返していたが，保存的に経過観察されていた．今回，意識消失にて救急搬送され，胃異所性膵に合併した潰瘍出血による貧血と診断された．手術加療目的で当院に紹介された．病変は3cm大で，幽門輪より2cmほど口側の胃前庭部に認めたが，combined laparoscopic and endoscopic approach for neoplasia with a nonexposure technique（CLEAN-NET）により幽門輪を温存して摘出可能と判断し，手術を行った．術中・術後の経過は良好で，術後第6病日に退院となった．病理所見は胃異所性膵で，切除断端は陰性であった．幽門輪に近接する胃異所性膵に対し，CLEAN-NETは有用であった．炎症，潰瘍形成を繰り返す胃異所性膵に対するCLEAN-NETの報告は，本症例が第1例目と思われる．

　This case report describes a 59-year-old male patient, who had been conservatively treated for aberrant pancreas with repeated acute pancreatitis. After a nine-year follow-up, the patient was transported by ambulance because of loss of consciousness, when he was diagnosed with anemia due to ulcer bleeding caused by recurrent aberrant pancreatitis. He was referred to our hospital for surgical treatment. Although the lesion was 3 cm in diameter and was located at the distal antrum, about 2 cm from the pylorus, we could excise the entire lesion and successfully preserve the stomach with a combined laparoscopic and endoscopic approach for neoplasia with a nonexposure technique （CLEAN-NET）. The postoperative course was uneventful, and the patient was discharged on postoperative day 6. The histopathological examination revealed that the tumor was gastric aberrant pancreas and the surgical margin was negative. To the best of our knowledge, this report is considered the first report of a case of gastric aberrant pancreas with repeated acute inflammation, treated with CLEAN-NET.