腹腔鏡下に切除した多房性囊胞状腫大を呈する虫垂憩室炎の1例

A case of appendiceal pseudo diverticulitis presenting as a multilocular cystic lesion treated by laparoscopic appendectomy

◆要旨：症例は49歳，男性．腹痛，下痢にて当院に来院した．腹部CTにて多房性囊胞状腫大を呈する虫垂を認めたため，多房性囊胞状腫大を伴う虫垂憩室炎と診断した．血液生化学所見と画像所見にて強い炎症が示唆されたため，早急に腹腔鏡下虫垂切除術を行うこととした．腹腔内を観察したところ，腫瘤を形成した虫垂と膿瘍を認めた．切除標本では，虫垂に多発する憩室を認め，病理組織検査結果では虫垂に仮性憩室が多発し，高度の炎症細胞浸潤を認めた．多房性囊胞状腫大を呈する虫垂憩室炎に対する腹腔鏡手術についての報告は本邦でも少なく，文献的な考察を含めて報告する．

　A 49-year-old man was referred to our hospital complaining of abdominal pain and diarrhea. Abdominal CT revealed a multilocular cystic lesion of the appendix, and we diagnosed appendiceal diverticulitis. Because laboratory data and imaging findings suggested the presence of severe inflammation, immediate laparoscopic appendectomy was performed. On laparoscopic view, a mass lesion of the appendix and abscess was detected. The resected specimens showed multiple appendiceal diverticula, histopathological examination of resected specimen revealed acute inflammation at the pseudo diverticulosis. Laparoscopic appendectomy for appendiceal diverticulitis with multilocular cystic lesion has rarely been reported, so we report this case with a review of the literature.